Podcasts about myocardial

In this milestone 50th episode of the Nextflow podcast, host Phil Ewels sits down with Krešimir Beštak, a PhD student and active contributor to the nf-core community, to explore an exciting frontier in bioinformatics: microscopy and spatial omics.While Nextflow is traditionally associated with genomics workflows, Krešimir shares how it's being used to power image analysis pipelines like MCMICRO, supporting complex research into cardiovascular disease and cancer diagnostics. Based at the University Hospital Heidelberg, Krešimir discusses his transition from master's student to PhD researcher, the translational applications of spatial proteomics, and how Nextflow enables reproducible workflows far beyond its original scope.00:00 Podcast Ep 50: Krešimir00:09 Welcome and introductions03:13 Introduction to Spatial Omics04:26 Multiplexing markers06:38 Metabolite microscopy07:23 Myocardial multiomics08:58 Microscopy data analysis11:32 nf-core/mcmicro13:05 2D vs 3D microscopy13:38 Computational bottlenecks within analysis15:43 Other nf-core imaging pipelines18:36 Downstream analysis after molkart19:53 Manual interventions23:27 Minerva25:39 Google Maps for cells27:16 Microscopy community around Nextflow30:34 How to get involved31:38 Changes in Nextflow for microscopy32:43 Nextflow Ambassador program33:17 Conclusion

N Engl J Med 2005;353:1095-1104Background: Prior trials on revascularization in patients with acute coronary syndromes without ST-segment elevation have yielded mixed results. While FRISC II and TACTICS-TIMI 18 demonstrated a significant reduction in myocardial infarction, this benefit was not observed in RITA 3. None of these trials showed a significant reduction in mortality. Further research is needed to guide treatment strategies in this population, particularly after the introduction of early use of clopidogrel and intensive lipid-lowering therapy.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial sough to test the hypothesis that an early invasive strategy is superior to selective invasive strategy for patients with non-ST elevation myocardial infarction (NSTEMI).Patients: Eligible patients had to have all of the following: Worsening symptoms of ischemia or symptoms at rest with the last episode being 24 hours before randomization, elevated cardiac troponin T level (≥0.03 μg per liter); and either ischemic EKG changes (defined as ST-segment depression or transient ST-segment elevation exceeding 0.05 mV, or T-wave inversion of ≥0.2 mV in two contiguous leads) or a documented history of coronary artery disease.Patients were excluded if they were older than 80 years, had an indication for primary percutaneous coronary intervention or fibrinolytic therapy, hemodynamic instability or overt congestive heart failure, oral anticoagulant drugs use in the past 7 days, fibrinolytic treatment within the past 96 hours, percutaneous coronary intervention within the past 14 days, elevated bleeding risk, plus others.Baseline characteristics: The trial randomized 1,200 patients from 42 Dutch hospitals – 604 randomized to early invasive strategy and 596 randomized to selective invasive strategy.The average age of patients was 62 years and 74% were men. Approximately 39% had hypertension, 14% had diabetes, 35% had hyperlipidemia, 23% had prior myocardial infarction and 41% were current smokers.Approximately 48% of the patients had ST deviation equal to or greater than 0.1 mV.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo early invasive vs selective invasive strategy.Patients received 300 mg of aspirin at the time of randomization, followed by at least 75 mg daily indefinitely, and enoxaparin (1 mg/kg for a maximum of 80 mg) subcutaneously twice daily for at least 48 hours. The early use of clopidogrel (300 mg immediately, followed by 75 mg daily) in addition to aspirin was recommended to the investigators after the drug was approved for acute coronary syndrome in 2002. Intensive lipid-lowering therapy, preferably atorvastatin 80 mg daily or the equivalent was recommended as soon as possible after randomization. All interventional procedures during the index admission were performed with the use of abciximab.Patients assigned to the early invasive strategy were scheduled to undergo angiography within 24 - 48 hours after randomization. Patients assigned to the selective invasive strategy underwent coronary angiography if they had refractory angina despite optimal medical therapy, hemodynamic or rhythm instability, or significant ischemia on pre-discharge exercise test.In both groups, percutaneous coronary intervention (PCI) was performed when appropriate, without providing more details in the manuscript.The level of creatine kinase MB was measured at 6-hour intervals during the first day, after each new clinical episode of ischemia, and after each percutaneous revascularization procedure.Endpoints: The primary endpoint was a composite of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year.The estimated sample size to provide 80% power to detect 25% relative risk difference between the two treatment groups at 5% alpha was 1,200 patients. This assumed that 21% of the patients in the early invasive arm would experience the primary outcome.Results: During the index admission, 98% of the patients in the early invasive strategy arm underwent coronary angiogram compared to 53% in the selective invasive arm. At 1-year, 79% of the patients in the early invasive strategy arm underwent revascularization compared to 54% in the selective invasive arm.The primary outcome was not significantly different between both treatment groups (22.7% with early invasive vs 21.2% with selective invasive, RR: 1.07; 95% CI: 0.87 - 1.33; p= 0.33). All-cause death was the same in both groups (2.5%). Myocardial infarction was significantly higher with the early invasive strategy (15.0% vs. 10.0%, RR: 1.50, 95% CI: 1.10 – 2.04; p= 0.005), while rehospitalization for angina was lower with early invasive (7.4% vs. 10.9%, RR: 0.68, 95% CI: 0.47 – 0.98; p= 0.04). Most myocardial infarctions were revascularization related and these were significantly more frequent with early invasive (11.3% vs 5.4%). Spontaneous myocardial infarctions were 3.7% with early invasive and 4.6% with selective invasive and this was not statistically significant.Major bleeding, not related CABG, during the index admission was more frequent with the early invasive strategy (3.1% vs 1.7%).There were no significant subgroup interactions for the primary outcome, including based on ST deviation and troponin levels.Conclusion: In patients with NSTEMI, an early invasive strategy was not superior to selective invasive strategy in reducing the composite endpoint of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year. An early invasive strategy was associated with more myocardial infarctions with a number needed to harm of 20 patients, which was secondary to revascularization related myocardial infarction. An early invasive strategy reduced rehospitalization for angina with a number needed to treat of approximately 29 patients.The ICTUS trial showed that revascularization can cause harm and highlighted how counting procedural myocardial infarctions can influence outcome estimates. While there is ongoing debate about the significance of periprocedural myocardial infarctions, evidence indicates an association with increased mortality. Whether periprocedural myocardial infarctions are 'less severe' than spontaneous myocardial infarctions remains controversial, as their impact varies based on infarct size and patient characteristics. This underscores the importance of including all-cause mortality or advanced systolic heart failure as endpoints in trials of revascularization.Patients in ICTUS received better background medical therapy compared to prior trials in this area. While this could be responsible for the divergent results compared to other prior trials. It also highlights the heterogeneity of NSTEMI patients and that an invasive strategy is not appropriate for all.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

The Lancet 2002;360:743-751Background: The TACTICS-TIMI 18 trial showed that an early invasive strategy in beneficial in selected patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI). These positive findings contrasted the findings from some earlier studies.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The British Heart Foundation RITA 3 randomized trial sought to compare invasive vs conservative strategy in patients with unstable angina or NSTEMI, similar to the trial question of TACTICS-TIMI 18.Patients: Eligible patients had suspected cardiac chest pain at rest with at least one of the following: Evidence of ischemia on electrocardiogram (ST depression, transient ST elevation, old left bundle branch block, or T wave inversion), pathologic Q waves suggesting previous myocardial infarction, or documented coronary artery disease on prior coronary angiogram.Patients were excluded if they had evolving myocardial infarction in which reperfusion therapy was indicated. Patients were also excluded if creatine kinase or creatine kinase MB concentrations were twice the upper limit of normal before randomization, if they had myocardial infarction within a month, had percutaneous coronary intervention (PCI) in the previous 12 months, or coronary artery bypass grafting (CABG) at any time.Baseline characteristics: The trial randomized 1,810 patients – 895 randomized to the invasive strategy and 915 randomized to conservative strategy. Patients were recruited from 45 hospitals in England and Scotland.The average age of patients was 63 years and 62% were men. Approximately 35% had hypertension on drugs, 13% had diabetes and 28% had prior myocardial infarction.The majority (92%) of the patients were enrolled because they met the criteria for evidence of ischemia on electrocardiogram.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive vs conservative strategy.In the conservative arm, patients received aspirin and enoxaparin 1mg/kg subcutaneously twice a day for 2-8 days. Beta-blockers, other antiplatelets and glycoprotein IIb/IIIa inhibitors could also be used. Coronary angiography could be performed if patients had anginal symptoms at rest or with minimal exertion despite appropriate therapy or if they had ischemia on stress testing.Patients in the invasive strategy arm received similar medical therapy to the conservative arm. Coronary angiogram was to be performed as soon as possible after randomization and ideally within 72 hours. Revascularization was recommended for lesions of at least 70% stenosis or 50% or more if left main.Endpoints: The trial had two co-primary outcomes. The first was a composite of death from any cause, nonfatal myocardial infarction, or refractory angina at 4 months. The second was a composite of death from any cause or nonfatal myocardial infarction at 1 year.Analysis was performed based on the intention-to-treat principle. The estimated sample size to provide 80% power at 5% alpha, was 1,770 patients. This assumed that 12% of the patients in the conservative arm would experience the outcome of death or non-fatal myocardial infarction at 1-year, and that the invasive strategy would result in 33% relative risk reduction in this outcome.Results: In the invasive strategy, 97% of the patients underwent coronary angiogram at a median of 2 days after randomization, and 55.3% underwent PCI or CABG. In the conservative arm, 10.3% had revascularization during the index admission, and 17.3% had revascularization at 1-year. The median follow time was 2 years and 97% of the patients had at least 1-year of follow up.The first primary composite outcome of death from any cause, nonfatal myocardial infarction, or refractory angina at 4 months was lower with the invasive strategy (9.6% vs 14.5%, HR: 0.66, 95% CI: 0.51 – 0.85; p= 0.001). The second primary composite outcome of death from any cause or nonfatal myocardial infarction at 1 year was not significantly different between both groups (7.6% with invasive vs 8.3% with conservative, HR: 0.91, 95% CI: 0.67 – 1.25; p= 0.58). At 1-year, 4.6% patients died in the invasive arm compared to 3.9% in the conservative arm, and this was not statistically significant. Myocardial infarction at 1-year occurred in 3.8% of the patients in the invasive arm compared to 4.8% in the conservative arm, and this was not statistically significant as well.All bleeding occurred in 8.2% in the invasive arm and 3.5% in the conservative arm.Subgroup analysis showed that men benefited from an invasive strategy while women did not (p for interaction= 0.011). The endpoint of death or myocardial infarction at 1-year, in women, was 5.1% in the conservative arm and 8.6% in the invasive arm, while in men, the incidence of this endpoint was 10.1% in the conservative arm and 7.0% in the invasive arm.Conclusion: In patients with unstable angina or NSTEMI, an invasive strategy compared to conservative strategy, reduced refractory angina but not myocardial infarction or death at 1-year.The reduction in angina is a subjective endpoint, prone to bias and faith healing, as we have previously discussed in other trials of PCI. The reduction in this endpoint alone should not justify widespread adoption of invasive strategy for unstable angina or NSTEMI.A key distinction between this trial and TACTICS-TIMI 18—which demonstrated a reduction in myocardial infarction with an invasive approach—is that this study included patients with smaller myocardial infarctions. Only 41% of participants had ST depression or transient ST elevation, and patients were excluded if creatine kinase or creatine kinase MB levels were more than twice the upper limit of normal before randomization. This highlights the heterogeneity among patients with unstable angina and NSTEMI, where baseline risk and the extent of myocardial necrosis influence treatment effects. We encourage you to read again the subgroup interactions of TACTICS-TIMI 18.Additionally, in the current era, high-sensitivity troponin assays enable the detection of smaller myocardial infarctions, potentially limiting the applicability of older trial results to all present NSTEMI patients.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Significance of Coronary Artery Calcifications and Ischemic Electrocardiographic Changes Among Patients Undergoing Myocardial Perfusion Imaging

Enduring the tumultuous journey of heart condition diagnosis and treatment led me, Jeff Holden, to realize the profound need for a supportive community and reliable information. Reflecting on my own experiences, from the initial confusion and misdiagnosis to the breakthrough testing and subsequent surgery at Stanford, I've been driven to share insights that can empower others in similar situations. This episode marks a significant milestone with the release of my new book, Imperfect Heart: Stories of Myocardial Bridges, a tangible resource aimed at providing solace and understanding to those who prefer something beyond digital content. Through patient stories and expert interviews, I've assembled a wealth of knowledge that addresses the myriad challenges faced by patients, families, and healthcare professionals alike. Together with the relentless dedication of our Facebook group participants, the administrators, Rob and Stephanie, and the rest of the team, our community has flourished, expanding from 1,200 to over 2,600 members in just two years. This growth underscores our collective mission to raise awareness and foster understanding of heart conditions. It also emphasizes the need for a book as well. My hope is that this book will serve as an invaluable tool not only for individuals grappling with their diagnosis but also for medical professionals who need a deeper grasp of patient experiences. By sharing these narratives and insights, I aim to reach those who aren't digitally inclined and provide a cornerstone of support that bridges gaps in communication and knowledge across all fronts. Now we finally have... a book, the book, my book. Get your copy of Imperfect Heart:Stories of Myocardial Bridges HERE.

My links:My Ko-fi: https://ko-fi.com/rhetoricrevolutionSend me a voice message!: https://podcasters.spotify.com/pod/show/liam-connerlyTikTok: ⁠https://www.tiktok.com/@mrconnerly?is_from_webapp=1&sender_device=pc⁠Email: ⁠rhetoricrevolution@gmail.com⁠Instagram: https://www.instagram.com/connerlyliam/Podcast | Latin in Layman's - A Rhetoric Revolution https://open.spotify.com/show/0EjiYFx1K4lwfykjf5jApM?si=b871da6367d74d92YouTube: https://www.youtube.com/@MrConnerly 

N Engl J Med 2013;369:1115-23Background: The COURAGE trial was published in 2007. It compared up-front PCI to medical therapy alone in patients with stable CAD. Preventive PCI did not reduce the chance of dying or having a heart attack over a median follow up time of 5 years. The results rocked the cardiology world because for years prior to the publication of COURAGE, the standard of care called for revascularization of obstructive coronary stenosis. Despite what we would consider minor criticisms of COURAGE, the results have held over time as a preventive PCI strategy has failed repeatedly to reduce death or MI compared to medicine alone in subsequent large trials (BARI 2D, FAME 2, ISCHEMIA and ISCHEMIA-CKD) involving patients with stable CAD. But what about patients with acute coronary syndromes who have, a clearly defined “culprit” lesion and stable coronary stenosis of a non-infarct vessel? On the surface, the answer might seem simple - treat the “culprit” lesion with PCI and leave the stable disease alone. Continue optimal medical treatment of stable CAD indefinitely with consideration of revascularization only if new symptoms arise. But what if a stable coronary stenosis behaves differently in a patient with an acute coronary syndrome than in patients without it? Are these patients predisposed or particularly susceptible to acute plaque rupture and thrombogenesis to such an extent that they would benefit from a preventive revascularization strategy? The Primary Angioplasty in Myocardial Infarction (PRAMI) trial sought to test the hypothesis that immediate preventive PCI of non-culprit vessels plus the culprit vessel compared to culprit vessel only PCI would improve outcomes in patients with a STEMI and coronary stenosis of a non-infarct related artery.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: From 2008 through 2013, patients were enrolled from 5 coronary care centers in the United Kingdom. Patients could be any age with acute STEMI and multivessel CAD detected at the time of emergency PCI. The trial was limited to patients with STEMI because ST-segment elevation, unlike ST-segment depression, localizes the area of ischemia in the myocardium and an “infarct-artery” is usually easy to distinguish. Clinically stable patients were considered for eligibility after undergoing PCI of the infarct artery while they were in the catheterization lab. They were eligible if successful PCI of infarct artery was performed and there was stenosis of 50% or more in one or more non-infarct arteries. Exclusion criteria included cardiogenic shock, previous CABG, had left main or significant disease in the ostia of both the LAD and circumflex vessels, or if the only non-infarct stenosis was a chronic total occlusion.Baseline characteristics: The trial screened 2,428 patients and randomized 465 patients (19%) with 234 to preventive PCI and 231 to no preventive-PCI. The majority of patients were excluded for single vessel disease (1122/1922 [58%]). The average age of patients was 62 years and more than 75% were men. Close to 50% were current smokers. The infarct artery was anterior in 35%, inferior in 60% and lateral in 5%. Approximately 65% of patients had 2 vessel disease and 35% had 3 vessel disease.Procedures: After completion of PCI in the infarct artery, eligible patients were randomized and those assigned to the preventive-PCI group underwent the procedure immediately in all non-infarct arteries with a coronary stenosis >50%. PCI was discouraged at a later date (sometimes this strategy is referred to as “staged PCI”) in the no preventive-PCI group unless it was symptom driven. Any patient in the trial with subsequent symptoms of angina that were not controlled with medicine was required to undergo objective assessment of ischemia to secure a diagnosis of refractory angina. Follow-up information was collected at 6 weeks and then yearly thereafter.Endpoints: The primary endpoint was a composite of death from cardiac causes, nonfatal MI, or refractory angina. Secondary outcomes included the individual components of the composite endpoint along with noncardiac death and repeat revascularization. Myocardial infarction was defined as symptoms of cardiac ischemia and a troponin level >99% URL. However, within 14 days after randomization, MI diagnosis also required ECG evidence of new STE or left bundle branch block and angiographic evidence of coronary artery occlusion (essentially this makes it so only in-stent thrombosis or spontaneous STEMI count and other causes of peri-procedural MI do not - this would bias the trial in favor of the preventive-PCI group).Refractory angina was defined as angina despite medical therapy and objective evidence of myocardial ischemia (i.e., ischemia on ECG during spontaneous episode of pain or abnormal results on functional testing).It was determined that 600 patients would be needed to achieve 80% power to detect a 30% relative reduction in the preventive-PCI group, at a 5% level of significance, assuming an annual rate of the primary outcome of 20% in the control group. Stopping criteria were prespecified if the results from the trial showed a primary outcome difference at the 0.001 level of significance. Results: The trial was stopped early based on a significant difference (P50%, preventive PCI significantly reduced a primary composite outcome of cardiac death, nonfatal MI and refractory angina in the PRAMI trial with an estimated NNT of 7 patients over 2 years. Individual components of the primary endpoint that were significantly reduced included nonfatal MI and refractory angina by similarly large margins. These results may seem impressive at first glance but we urge extreme caution in their interpretation. First, this is a relatively small trial with a historically large effect size, especially when considering hard endpoints like cardiac death and nonfatal MI were included. Such results are often later found to be falsely positive when larger, confirmatory studies are conducted. Second, the trial was stopped early and early stopping is prone to yield false positive and/or exaggerated results. Third, inclusion of refractory angina in the primary endpoint, an endpoint susceptible to bias in an unblinded study (see earlier discussion of “faith healing” and “subtraction anxiety” in FAME 2; consideration also must be given to nocebo effects in patients who know they have “untreated blockages”), clouds the main findings by inflating the effect size and making the trial susceptible to large differences in underpowered endpoints before sufficient data can be accumulated on hard outcomes. For example, if the trial had sought to detect a conservative difference of 30% in a primary composite endpoint that only included cardiac death or nonfatal MI, based on an event rate of 12% in the control group (the actual event rate in the trial), over 2,200 patients would be needed for 80% power at a 5% level of significance. The estimated number of actual events would be around 230. However, only 47 events occurred in PRAMI making the results highly susceptible to noise.While results of PRAMI suggest a beneficial role for preventive-PCI in patients with STEMI, more evidence is needed to confirm the results.Thanks for reading Cardiology Trial's Substack! This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241296412

Commentary by Dr. Giselle Melendez

Commentary by Dr. Ali Javaheri

The EVOLVED trial investigated whether early aortic valve intervention could improve outcomes in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. The randomized, multicenter study of 224 patients found no significant difference in all-cause mortality or unplanned aortic stenosis-related hospitalizations between early intervention and guideline-directed conservative management. However, early intervention was associated with lower rates of NYHA class II-IV symptoms and fewer unplanned hospitalizations. The trial highlights the potential symptomatic benefits of early intervention but underscores the need for further research to assess long-term outcomes.

Embarking on a quest for answers, Steve Millington faced a world of mystery when his heart first sent distress signals at just 22. Misdiagnosed and misunderstood, Steve's journey through unrelenting chest pain took him from Australia to Sweden, and eventually across Europe, in search of clarity and care. With the steadfast support of his partner Kim, Steve's path was fraught with skepticism from the medical community and financial burdens that threatened to overshadow his fight for health. This episode chronicles not just a physical journey, but a testament to resilience and the power of unyielding self-advocacy. Across continents and healthcare systems, Steve's search for a solution to his symptomatic heart bridge was anything but conventional. Failing to find resolution within European borders, Steve's story led him to Pakistan, where Dr. Takir Akbar recognized the urgency of his condition. This wasn't just a leap of faith but a critical pivot in a long-fought battle against medical uncertainty. Discover how Steve navigated the complexities of international healthcare and challenged preconceived notions about medical treatment abroad, ultimately finding hope and healing in unexpected places. The cost of pursuing heart health extended beyond financial struggles to emotional and mental challenges, as Steve navigated a landscape that often felt isolating. With courage, he faced the obstacles of delayed diagnoses and skeptical professionals, advocating for himself in a world that didn't always provide clear answers. Through his experiences, we are reminded of the crucial role of perseverance and the pursuit of all possible options, regardless of geographic or financial boundaries. Join us as we unravel Steve's inspiring tale of navigating the intricacies of global healthcare and the undying spirit of someone who refuses to give up. Chapter Summaries (00:00) Steve Millington's Heart Journey Steve's journey with persistent health symptoms, misdiagnosis, and support from his partner, leading to seeking medical attention. (11:46) Desperate Search for Heart Surgery Desperate search for treatment of rare heart condition spans multiple countries, facing skepticism and insurance complications. (21:20) Heart Surgery Journey in Pakistan Transformative journey to Pakistan for medical procedure, highlighting excellent care and cost-effectiveness, with unexpected post-surgery complications. (31:16) Financial Challenges in Seeking Medical Care Becoming a health advocate, researching reliable information, and seeking affordable treatment for COVID vaccine-related conditions. (36:22) Navigating Heart Health Treatment Options Proactive health management, securing loans for surgeries, self-advocacy, and risks of untreated cardiac issues. (49:16) Journey to Affordable Heart Surgery Steve's journey of undergoing open heart surgery in Pakistan due to cost constraints and lack of proper diagnosis, highlighting the importance of perseverance and exploring all possible avenues for better health outcomes.  

N Engl J Med 2008;358:557-567Background: ST-segment elevation myocardial infarction (STEMI) is caused by disruption of an atherosclerotic plaque, leading to intraluminal thrombosis that partially or completely blocks the coronary artery. Opening the blocked artery using percutaneous coronary intervention (PCI) restores blood flow and is the standard of therapy for these patients. In many patients, spontaneous embolization or embolization caused by thrombus fragmentation during PCI can lead to small thrombi migrating distally and obstructing the coronary microcirculation. This is associated with increased infarct size, reduction in left ventricular recovery and increased risk of mortality.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Several devices designed to retrieve intracoronary thrombus have been developed and have demonstrated improved coronary reperfusion in small studies. The Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS) sought to compare the efficacy of thrombus aspiration versus conventional PCI in patients with STEMI.Patients: Eligible patients were recruited from a single center in Netherlands. Patients had STEMI with symptoms lasting more than 30 minutes but less than 12 hours. The EKG criteria were ST-segment elevation of >1mm in at least two leads.Patients were excluded if they had rescue PCI after thrombolysis or if life expectancy was less than 6 months.Baseline characteristics: The trial randomized 1,071 patients – 535 randomized to thrombus aspiration and 536 randomized to conventional PCI.The average age of patients was 63 years and 70% were men. Approximately 35% had hypertension, 12% had diabetes, 25% had hyperlipidemia, 10% had prior myocardial infarction, and 47% were current smokers.Infarct-related vessel was the left anterior descending artery in 43% of the patients, the left circumflex artery in 17% and the right coronary artery in 38%.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo thrombus aspiration during PCI or conventional PCI. All placed stents were bare-metal stents.Before PCI, patients received 500 mg of aspirin, 600mg of clopidogrel and 5000 IU of heparin. Patients also received the glycoprotein IIb/IIIa inhibitor abciximab, if not contraindicated, and additional heparin during the procedure.Endpoints: The primary end point was the postprocedural frequency of a myocardial blush grade of 0 or 1. Secondary end points included complete resolution of ST-segment elevation and the absence of persistent ST-segment deviation. Clinical endpoints were also assessed as part of the secondary endpoints and included target-vessel revascularization, reinfarction or death, at 30 days.A 12-lead EKG was obtained at presentation and again at 30 to 60 minutes after PCI, and the ST-segments on the postprocedural EKG were compared with those at presentation.Not to readers: Myocardial blush is a qualitative angiographic method used to assess microvascular perfusion during coronary angiography. It evaluates how well contrast dye penetrates the myocardium. The grading of myocardial blush was: 0: no myocardial blush, 1: minimal myocardial blush or contrast density, 2: moderate myocardial blush or contrast density but less than that obtained during angiography of a contralateral or ipsilateral non–infarct-related coronary artery, and 3: normal myocardial blush or contrast density, similar to that obtained during angiography of a contralateral or ipsilateral non–infarct-related coronary artery. Persistent myocardial blush suggests leakage of contrast medium into the extravascular space and was given a grade of 0.Analysis was performed based on the intention-to-treat principle. To achieve 80% power with a two-sided alpha of 0.05, a total of 1,080 patients would be needed to detect a 25% reduction in the primary endpoint with thrombus aspiration compared to conventional PCI. This calculation assumed a 30% rate of myocardial blush grade 0 or 1 in the conventional PCI group.Results: Among the 1,161 patients screened for inclusion, 1,071 (92.2%) were randomized. Approximately, 94% of the patients in both groups underwent PCI. Among patients who underwent PCI in the thrombus aspiration group, 89% underwent thrombectomy. Among the patients who underwent thrombus aspiration, histopathological examination showed atherothrombotic material in 331 (72.9%) patients.The primary outcome of myocardial blush grade 0 or 1 was significantly lower in the thrombus aspiration group (17.1% vs 26.3%, RR: 0.65, 95% CI: 0.51 - 0.83; p

Facing unexpected health challenges can be a monumental experience, as lifelong athlete John Chan discovered when he encountered severe chest pains during an ultra marathon. Join us as he recounts his compelling journey from initial denial to acceptance of his heart condition, navigating a complex medical landscape as the youngest patient in his cardiologist's office. John's story is one of resilience, determination, and the profound realization that health challenges can change one's perspective on life. The recognition his gift of recovery, created a reflective and appreciative mindset at first, only to fall back into his lifestyle prior to the presentation of symptoms and subsequent surgery.  John takes us through the emotional and mental preparation for his heart surgery, painting a vivid picture of the virtual orientation with Dr. Balkhy that eased his fears and brought clarity. This pivotal moment highlights the importance of trusting medical expertise while balancing it with personal goals and emotional wellbeing. Discover how John's journey underscores the necessity of a comprehensive approach to major health decisions, where spiritual and gratitude aspects coexist with medical concerns. As John celebrates his remarkable recovery journey, he emphasizes the power of openness and shared experiences in fostering hope. Whether it's the poignant moment of enjoying a Chicago deep-dish pizza before surgery or advocating for regular health check-ups, John's narrative encourages proactive health management. His heartfelt gratitude for the support from his medical team and the community underlines the  impact of sharing personal health stories and building a network of hope for those facing similar challenges. It's the realization of the need to return the favor of support and gratitude for the gift of recovery that makes this story so unique, and John the man of character he is, in his return to appreciation for all that has happened for him. Chapter Summaries: (00:00) Journey to Heart Health John Chan's journey from athlete to confronting heart issues, including disbelief, medical tests, and navigating the healthcare system as a young patient. (14:45) Surgical Decision Making Process Dr. Balkhy's virtual orientation session for a medical procedure focused on understanding the patient's journey, goals, and trust in the medical team's expertise. (18:58) Life-Changing Heart Surgery Recovery Preparing for surgery, meeting Dr. Balkhy, and reflecting on life's legacy and gratitude during recovery. (32:59) Sharing Hope and Gratitude Sharing personal health experiences to inspire and provide hope, emphasizing proactive management and advocating for men's health. (41:46) Gratitude and Shared Hope Gratitude and hope in recovery journeys, support from medical professionals, and sharing personal experiences to inspire others.  

I was doing some work with AI for a project and I wondered what I would find if I began a conversation about myocardial bridges. To my amazement, the responses to my questions were quite contemporary, on point for the most part and very much aware of the condition without doubt. I found the answers to be as technical as I wanted to get or as general given what I asked. The overall takeaway for me, was that there was little downside or disinformation. The entire conversation was pro myocardial bridges as we know them. If we could only get the majority of our medical community to be as receptive to the condition as our AI is, there would be far fewer people suffering from the condition and, in my opinion, far fewer deaths from cardiac arrest. We're making progress and the more our digital/virtual resources endorse the corrective procedures for a condition that is more common than other diseases like cancer and stroke, the better off we're going to be. There's a lot in the episode as we cover a lot of ground. It's one worth taking notes on if you find areas of interest. I hope the episode gives you some additional support to share with whomever you're trying to convince that what you're experiencing is real. It should also enlighten you to the capability of what AI can provide us with regard to information about myocardial bridges. It gives me tremendous encouragement to see that AI is initially very receptive to the techniques for correction of a bridge.  Here's to a future of acute awareness of MB's and to procedures and techniques to remedy them. I know one place we can go to get comfort in knowledge! Enjoy the episode.

EVOLVED: Early Intervention in Patients with Asymptomatic Severe Aortic Stenosis and Left Ventricular Myocardial Fibrosis

rWotD Episode 2792: Myocardial scarring Welcome to Random Wiki of the Day, your journey through Wikipedia’s vast and varied content, one random article at a time.The random article for Wednesday, 25 December 2024 is Myocardial scarring.Myocardial scarring is the accumulation of fibrous tissue resulting after some form of trauma to the cardiac tissue. Fibrosis is the formation of excess tissue in replacement of necrotic or extensively damaged tissue. Fibrosis in the heart is often hard to detect because fibromas, scar tissue or small tumors formed in one cell line, are often formed. Because they are so small, they can be hard to detect by methods such as magnetic resonance imaging. A cell line is a path of fibrosis that follow only a line of cells.This recording reflects the Wikipedia text as of 00:45 UTC on Wednesday, 25 December 2024.For the full current version of the article, see Myocardial scarring on Wikipedia.This podcast uses content from Wikipedia under the Creative Commons Attribution-ShareAlike License.Visit our archives at wikioftheday.com and subscribe to stay updated on new episodes.Follow us on Mastodon at @wikioftheday@masto.ai.Also check out Curmudgeon's Corner, a current events podcast.Until next time, I'm generative Amy.

This episode includes graphic video and a detailed explanation of the "unroofing procedure" from the operating room and is best when viewed on the "Imperfect Heart" YouTube Channel. In this, the third in a series on the "Vollmer Journey", we uncover the transformative potential of robotic myocardial bridge unroofing surgery as we bring you an insightful conversation with Dr. Johannes Bonatti, a pioneer in the field now practicing at University of Pittsburgh Medical Center, and David Vollmer, the patient who experienced its benefits firsthand. Hear how robotic techniques are redefining unroofing surgery, offering significant advantages over traditional methods, including quicker recovery times. David shares his remarkable journey back to full physical activity in just three months, shedding light on the decision-making process and the crucial role of provocative testing in determining the necessity of surgery. Step into the state-of-the-art hybrid operating room where technology meets surgical expertise. Dr. Bonatti reveals how the DaVinci robot enhances the precision of procedures like robotic unroofing of myocardial bridges. Gain an understanding of the importance of work on a resting heart and the process to make that happen. Additionally, explore the vital function, in detail, of the heart-lung machine in maintaining circulation during surgery, providing insights into the meticulous care involved in these advanced procedures. We'll discuss the complexities and risks of robotic heart surgery, with Dr. Bonatti as he details the nuance and novelty when compared to thorocotomy or sternotomy. We discuss the subject of myocardial bridges and their potential links to sudden cardiac events, highlighting the growing recognition of these conditions in the medical community. As we close this third episode of the series, it truly is a celebration of patient recovery and the dedication of Dr. Bonatti and his team, inspiring confidence in the future of myocardial bridge repair both robotically and traditionally. We continue to provide evidence of successful outcomes of this somewhat controversial procedure to provide hope for those with the condition and looking for solutions. To learn more about UPMC and their innovative robotic cardiac care, you can find more by cliking on this LINK You can also call the department at 412-648-6200, option 7 when prompted. CHAPTER SUMMARIES (00:00) Robotic Heart Surgery Dr. Bonatti and David Vollmer discuss the decision-making process and benefits of robotic cardiac surgery, including quicker recovery times. (15:37) Robotic Heart Surgery Robotic totally endoscopic unroofing of LAD myocardial bridge using DaVinci robot in hybrid OR with CO2 insufflation and heart-lung machine support. (35:20) Managing Risks in Robotic Heart Surgery Cardioplegia and hemostatic agents are used in robotic heart surgery, with a focus on patient safety and positive experiences at UPMC. (40:28) Myocardial Bridges and Robotic Surgery Nature's risks in cardiac surgeries, including pericarditis and atrial fibrillation, and the role of myocardial bridges and advancements in robotic technology. (52:04) Robotic Heart Surgery Success Story Successful recovery from surgery, addressing mineral deficiency and absence of AFib, with innovative approach by Dr. Bonatti at UPMC.  

Unlock the secrets of properly understanding and diagnosing myocardial bridges with insight from Dr. Jeffrey Fowler, a leading interventional cardiologist at University of Pittsburgh Medical Center. Our conversation promises to illuminate the often perplexing process of diagnosing these cardiac anomalies and their impact on heart function. Through the lens of minimally invasive procedures and advanced imaging techniques like coronary CT angiograms, Dr. Fowler demystifies why myocardial bridges are not always the main culprits behind chest pain and the definitive testing now being done to ascertain the significance of the myocardial bridge. We're going to explore the intricate world of invasive testing, as we detail the provocative testing process used to evaluate myocardial bridges, their severity and their contribution to angina, or chest pain. Dr. Fowler explains how starting with an empiric trial of medications can lead to more invasive procedures like heart catheterization if necessary. Learn about the steps of the provocative test and the role of acetylcholine in testing for endothelial dysfunction and vasospasm, with reassurances about the safety and reversibility of these tests. This episode is our first on the detail and best practice for diagnosis of the bridge through the provocative test we've heard so much about. It's meant for the education and knowledge for both patients and professionals, enhancing understanding of the nuanced approaches in relatively rare process of diagnosis. Celebrate the spirit of collaboration among cardiology experts as Dr. Fowler shares the necessity of communication and advice. He's consulted with many others along the way including Dr. Shaw at Yale and Dr. Tremmell at Stanford, highlighting real-world case studies like that of patient David Vollmer. Join me in this compelling narrative of breakthroughs and dedication in the realm of cardiac care, and discover how ongoing advancements promise a brighter future for patients everywhere. This episode also has a video component that can be found on the Imperfect Heart YouTube channel or by clicking on the link HERE. To reach Dr. Fowler call 412-647-6000 and ask for him specifically. Or you can visit the hospital website HERE . Dr. Fowler's email is: fowlerja@upmc.edu You can learn more about the Microvascular Network in the link HERE.

Commentary by Dr.  Jian'an Wang.

Commentary by Dr. Ning-I Yang.

Hey Heart Friends. I sit down with previous guest, Jeff Holden, to explore the profound changes heart surgery brings into one's life. Jeff recaps his own battle against myocardial bridging, recounting the gratitude he feels every day. From open-heart surgery to life-altering dreams, Jeff unpacks the layers of his experiences, revealing how overcoming a near-fatal condition has fueled his passion for advocacy and storytelling. Curious about the life-changing dream Jeff had after surgery? Tune in to understand why this dream has become the cornerstone of his new mission and find out how he's making a difference in the field of cardiology. Plus, discover the significance of a simple bracelet—a daily reminder to appreciate life's small blessings. Listen to Jeff's original episode here. You can find his podcast, My Imperfect Heart, anywhere you get your podcasts.Join the Patreon Community! The Joyful Beat zoom group is where you'll find connection and hope that you aren't alone in your journey.If you just want to support the show as a one-time gift (thank you), go here.**I am not a doctor and this is not medical advice. Be sure to check in with your care team about all the next right steps for you and your heart.**How to connect with BootsEmail: Boots@theheartchamberpodcast.comInstagram: @openheartsurgerywithboots or @boots.knightonLinkedIn: linkedin.com/in/boots-knightonBoots KnightonIf you enjoyed this episode, take a minute and share it with someone you know who will find value in it as well. You can share directly from this platform or send them to:Open Heart Surgery with Boots

Knowing I needed to find a cardiologist in my home community post surgery, left me a little disappointed to leave the confines of Stanford's outstanding care. After two years it seemed a good idea to reach out to see who might be the "lucky" doctor to get a patient like me. I'm pleased to say that the gentleman I was fortunate to be introduced to turned out to be very knowledgable about our condition and we had a very nice first consultation. Meeting Dr. Diwakar Lingam was a breath of fresh air as you're going to hear in this episode. His expertise offered reassurance, reminding me what a crucial role a well-informed cardiologist plays. This episode unfolds my first encounter with Dr. Lingam, a cardiologist who not only understood the complexities of our condition but also embraced the opportunity to share insights with our listeners. With his guidance, we explore what patients should seek in their healthcare providers, especially when navigating the oft-overlooked terrain of myocardial bridges. You'll hear me explain my personal medical narrative, from the initial bewildering diagnosis to the life-changing care I received at Stanford. Myocardial bridges are not just a medical anomaly but involve genetic factors and precise surgical interventions like unroofing surgery, which we dissect in our first discussion. Dr. Lingam understood the value of proper diagnosis, the role of advanced imaging techniques, and the often-missed symptoms that can complicate the path to treatment. This is a call to action for the cardiology community to bolster awareness and refine diagnostic approaches. Not many doctors would feel comfortable with a new patient, walking in with a recording device and asking to record the conversation in that very first meeting. Dr. Lingam was and I applaud him for his acceptance as this very simple gesture alone may allow this episode to be shared with other cardiologists who may not be as astute and aware of the need to treat a diagnosed MB patient differently. You can reach out to Dr. Lingam or share his contact information with a cardiologist you may want to connect with him at Roseville Cardiology Group. BIO Diwakar Lingam, M. D. graduated from Siddhartha Medical College, NTR University of Health Sciences, Vijayawada, India in 1994. He completed his residency at State University of New York (SUNY) Downstate Medical Center in Brooklyn, NY where he served as a Chief Resident of Internal Medicine. He completed his fellowship in Cardiovascular Disease from Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire. Dr. Lingam strongly believes in solid patient education to improve patient compliance with treatment and better health outcomes. He strives hard to help patients understand clearly the rationale behind all the tests, treatment choices and medications prescribed. He focuses his patient education on lifestyle changes and the value of diet and exercise in the management of many cardiac and medical issues of the patient. Dr. Lingam's clinical interests are preventive cardiology, cardiac imaging, and cardio-oncology. He loves to help patients with cancer treatment-related cardiac issues and patients interested in preventing cardiac and vascular problems. He lives in Folsom with his wife and two children. During his free time, he enjoys biking, playing chess, and spending time with family. (00:11) New Cardiologist Discusses Myocardial Bridges Meeting a new cardiologist after myocardial bridge surgery, discussing the importance of informed and empathetic care in cardiology. (04:51) Myocardial Bridges Myocardial bridges, unroofing surgery, genetic nature, accurate diagnosis, specialized care, radiation exposure, contrast use, diabetic patients, continued research. (17:30) Follow-Up Consultation on Treatment Plan Specialized centers, robotic surgery, statins, and follow-up care are important in treating cardiac conditions.

In today's VETgirl online veterinary CE podcast, we discuss transient myocardial thickening (TMT) in cats. If you just had a cat diagnosed with a heart murmur and had a cardiologist echo it, how do you know if it's TMT versus Hypertrophic Cardiomyopathy (HCM)? Tune in to find out what you need to know about this transient feline heart "thing!"

Abdullah Al-Abcha, MD, social media editor of JACC: Cardiovascular Interventions, and Sung Gyun Ahn, MD, PhD, discuss a recently published original research paper reporting the outcomes of failed thrombus aspiration in patients with STEMI and large thrombus burden.

Live from the Imperfect Heart meetup, this episode features an intimate and heartfelt roundtable discussion among the patients and their caregivers who have all experienced the effects of a myocardial bridge on their loved one. Participants share their personal stories, their reactions to the diagnoses, treatments, and ongoing struggles post surgery. They discuss the emotional and physical impacts of their journeys side-by-side with their loved one, the importance of a being supportive partner, and the value a caregiver provides in simply getting comfortable with a new life. Special attention is given to the dynamics of relationships under stress, the role of caregivers, and the significance of faith and perseverance. Some participants also share the specifics of various medical procedures they have undergone, including traditional and robotic heart surgeries, and the impact on their lives post-surgery as well as the changes in relationships once the procedure is complete. These candid conversations should provide a backdrop for others to see what success looks like in both the journey up to and post surgery. What an incredible group of partners everyone of the patients were so blessed to have. Episode Chapters 00:00 Introductions and Initial Thoughts 00:48 Jeff's Health Journey 02:50 Caregiver Experiences and Challenges 06:05 Decisions and Reflections on Surgery 09:13 Post-Surgery Realities and Adjustments 12:30 Unique Experiences and Perspectives 24:32 A Heart Attack Experience 24:48 Medical Journey and Challenges 27:25 Exploring Treatment Options 32:39 Family Impact and Discussions 39:41 Reflections and Realizations

Is there a right surgical approach that completely transforms the lives of patients with myocardial bridges? This episode is a live recording of the first ever myocardial bridge meetup where Dr. Theo Kofidis, took the time to virtually join us from Greece for the first session of the day. We learned of his ambitious project of revamping a JCI accredited hospital into a cutting-edge medical facility. He takes questions from the group  including attendee Jane's prolonged struggle with myocardial bridge symptoms and provides suggestions and support from his perspective. He shares insights into the significance of timely intervention and the crucial consideration of surgical options when medication fails. Questions from the group included best practices for unroofing a myocardial bridge. Dr. Kofidis outlines the meticulous surgical techniques that ensure optimal outcomes in his opinion. We dig deeper into the importance of global collaboration among healthcare professionals to enhance treatment efficacy and work toward identifying long term, symptom free patients to better support proper procedures for "unroofing". We spoke of advanced diagnostic tools like 3D reconstruction and high-frequency ultrasound that aid in post-operative evaluation, and heard why minimally invasive endoscopic approaches, complemented by tactile feedback, offer significant benefits. The group got expert advice on achieving comprehensive and precise surgical results for myocardial bridges that we're now sharing with anyone interested. Finally, we ventured into the realm of advanced diagnostics and the role of AI in cardiology. Dr. Kofidis discussed the underdiagnosed prevalence of myocardial bridges and their connection to coronary artery disease and coronary artery spasms. We conclude with an engaging discussion on medical tourism in Greece, highlighting its potential advantages and the robust support system within the medical community. Dr. Kofidis, as always, offers his expert advice and invites any concerned or interested party to reach out for a discovery call to see if Greece might be an option for you. What a special treat it was indeed. You cab reach Dr. Kofidis by email: tkofidis@hotmail.de Episode Chapter Summaries (00:00) Myocardial Bridge Treatment and ComplicationsDr. Kofidis discusses his transition to a new hospital, upcoming operations on myocardial bridge patients, and the importance of prompt treatment and medical options. (14:59) Optimal Methods for Myocardial Bridge UnroofingNature's intricacies of unroofing a myocardial bridge, collaboration between surgeons and cardiologists, and use of advanced diagnostic tools. (22:49) International Heart Surgery Center in AthensCT scanning technology and AI in cardiology improve accurate diagnosis of myocardial bridges and their relationship with coronary artery disease. (35:43) Heart Surgery Tourism ConversationDr. Kofidis and I discuss the pleasure of visiting Greece, medical tourism, and the supportive network within the medical community.    

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on renin-angiotensin system inhibition in patients with myocardial injury complicating TAVR.

What if the future of heart surgery didn't involve massive scars and long recovery times? On this episode we'll visit the pioneering world of minimally invasive cardiac procedures through the eyes of Dr. Allan Stewart, Medical Director and Chief of Cardiovascular Surgery at HCA Florida Mercy Hospital. A leading cardiac surgeon, his journey from childhood started with an understanding of mechanics that led to groundbreaking medical innovations. His path is nothing short of inspiring. Dr. Stewart shares the pivotal moments that led him to transform the field, including a captivating Nova episode on pediatric heart transplants, and his many years of practice using minimally invasive techniques. Ever wondered how surgeons tackle the complexities of myocardial bridges? Dr. Stewart takes us on a compelling journey through his unexpected dive into this challenging area while at Columbia University. He explains the intricacies of diagnosing and treating these conditions, and the critical decision-making involved in whether to perform surgeries on a beating heart or with a pump. From ensuring precision to avoid catastrophic complications like cutting the artery, to the difficulty of accurate diagnosis, this segment shines a light on both the art and science of cardiac surgery. Finally, we'll delve into the crucial importance of thorough and precise surgical intervention. Incomplete arterial surgeries can lead to devastating consequences, including the need for complex redo surgeries. Dr. Stewart emphasizes the necessity of proper techniques to prevent complications and stresses the importance of educating both patients and cardiologists about the risks associated with myocardial bridges and inappropriate stent use. Join us for this enlightening conversation, and on a lighter note, I look forward to a future bike ride together in South Florida. Don't miss this episode with one of the field's most innovative minds. To reach Dr. Stewart a voice mail or text message was suggested as best. 917-748-7836 To learn more about Dr. Stewart click on the link: Dr. Allan Stewart Episode Highlights (00:17 - 00:40) Becoming a Leading Cardiac Surgeon (03:55 - 05:37) Assessing Candidates for Thoracotomy (09:50 - 11:27) Minimally Invasive Approach in Surgery (14:20 - 15:46) Advanced Imaging Technology in Cardiology (18:58 - 19:57) Robotic vs Full Heart Surgery (23:01 - 23:52) Successful Artery Surgery Examination (31:15 - 33:04) Traveling for Specialized Medical Procedures Chapter Summaries (00:00) Cardiac Surgeon Discusses Minimally Invasive Procedures Dr. Stewart shares his journey to becoming a pioneer in less invasive cardiac surgeries, emphasizing the importance of minimizing trauma and improving cosmetic outcomes. (05:39) Advances in Myocardial Bridge Diagnosis My journey into addressing myocardial bridges began serendipitously and involves challenges such as diagnosis and surgical techniques. (19:59) Cardiac Surgery Complications and Stress Relief Proper surgical techniques and education are crucial in preventing complications and misdiagnosis of arterial bridges in heart surgery. (33:43) Importance of Complete Artery Surgery Nature's arterial bypass and stent surgeries, complications from incomplete procedures, and importance of thorough intervention.  

Send us a textHave you ever ignored a small discomfort only to realize it was something far more serious? Join us on "Heart to Heart with Anna" for an eye-opening conversation with Jeff, the creator and host of a non-profit podcast network, who discovered a congenital heart defect called a myocardial bridge at the age of 65. Jeff recounts his terrifying experience of cycling through strange symptoms and surviving a heart attack, ultimately learning the necessity of paying attention to one's body. Through his personal narrative, Jeff underscores the critical role of support networks and timely medical intervention in overcoming health challenges.What happens when traditional medical tests don't give you the answers you need? In this episode, we delve into the complexities of diagnosing and treating ventricular tachycardia and myocardial bridging. Jeff shares the life-saving journey that led him to create his podcast, "Imperfect Heart," focusing on raising awareness about these underdiagnosed conditions. From the importance of self-advocacy in medical settings to the need for better education in medical schools, Jeff's mission is to use his "bonus time" to make a positive impact on the lives of others. Listen in to learn about the life-changing potential of surgical intervention and the power of recognizing and acting on heart-related symptoms.Helpful Links:Jeff's Imperfect Heart podcast: https://www.myimperfectheart.com/Stanford's Myocardial Bridge Program: https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/myocardial-bridging.htmlWe're Rolling Studios' Instagram page: https://www.instagram.com/wererollingstudios/Thanks to our newest HUG Patron, Ayrton Beatty and long-standing Patrons: Laura Redfern, Pam Davis, Michael Liben, Nancy Jensen, Alicia Lynch, Deena Barber, Carlee McGuire, Carter & Faye Mayberry, and Frank Jaworski. We appreciate you!Support the Show.Anna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on changes and prognostic implications of myocardial work in aortic stenosis subtypes undergoing transcatheter valve implantation

Clinical Quantification of Myocardial Blood Flow Using PET   Guest: Panithaya Chareonthaitawee, M.D. Hosts: Malcolm R. Bell, M.D.   In this podcast, we will describe the clinical applications of PET MBF quantitation and discuss the strengths and limitations of PET MBF quantification.   Topics Discussed: Why has PET myocardial perfusion imaging seen such growth? You mentioned the ability of PET to measure myocardial blood flow. Why is this crucial? So, should myocardial blood flow measurement be standard in all PET MPI studies? Does it require special equipment or extra time? Are there specific values to remember for PET flow quantification?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog On the last Heath cast #662 we talked about the choice of doing nothing when faced with symptoms of hormone deficiency and symptoms of aging, versus the choice to actively live a healthy life. I believe that concentrating on yourself as you age can save your lifestyle and or your life!  Preventing illness as you age is as important as paying your taxes! An unhealthy living plan without replacing deficient hormones can lead you on  a road to illness and early death.  If that doesn't motivate you, then consider yourself warned. Recently I saw a man in his late 70s who I had seen about 7 years before this.  He and his wife entered my office, and I could see that some of my medical predictions had come true.  This man had developed every disease I told him his blood work and physical self-predicted. Despite the treatment plan I gave him, he ignored me on diet, exercise, supplements, stopping smoking and drinking I gave him 7 years earlier.  He admitted that everything I told him would happen, did happen and now he is in constant pain, he is morbidly obese, and has trouble even walking.  He now has diabetes and has had a heart attack and 7 ER admissions for his heart since.  He did not do one thing I told him, except just recently he stopped drinking alcohol. He now is ready to live a healthy lifestyle however since he has so many diseases, he spends an enormous amount of money on medications and medical care.  The cost of care was his reason to ignore hormones, but he ignored my lifestyle advice as well.  Even though now a lifestyle change and testosterone pellets will improve his life, he still has done damage to his blood vessels and heart not to mention his joints and back.  These aging changes I cannot prevent, just stop the rapid progression. When you become our patient, we ask you a variety of questions that help us design a treatment plan, more accurately named a “longevity plan”. Symptoms of Testosterone, Estradiol and Thyroid deficiency: A combined list of symptoms of aging for men and women include: Loss of Testosterone Symptoms: ·      Loss of sex drive ·      Loss of erections, and morning erections ·      Loss of orgasms for women ·      Fatigue ·      Insomnia ·      Depression/anxiety attacks ·      Loss of strength and muscle mass ·      Frailty ·      Can't think clearly or remember names of things ·      Loss of motivation ·      Loss of efficiency at work ·      Weight gain ·      Belly fat increase ·      Sagging skin ·      Arthritis ·      Osteoporosis Loss of estradiol (women): ·      Hot flashes ·      Night sweats ·      Anxiety attacks ·      Irritability ·      Dry vagina ·      Painful intercourse ·      Sagging skin ·      Frontal balding ·      Urine loss ·      Dry skin ·      Shrinking vagina ·      Osteoporosis ·      Arthritis    Thyroid deficiency: ·      Hair loss ·      Fat gain ·      Fatigue ·      Depression ·      Feels cold all the time ·      Very dry skin ·      All body swelling ·      Constipation ·      High cholesterol ·      Low blood pressure and pulse These symptoms above can be treated and in treating them you will experience not only a lack of symptoms, but a longer healthier life. However, if you also change your lifestyle you can avoid the diseases of aging too! Through replacing your deficient hormones, add only individually chosen supplements and develop a healthy whole food eating plan, with 3-7 days a week of exercise (1 hour/ session).    What do I mean? What is a healthy Lifestyle? ·      If you smoke STOP! ·      If you Drink more than 15 alcoholic drinks a week, then stop, If you aren't addicted to alcohol, you should decrease your drinking to < or = 7 drinks a week. ·      Exercise 30-60 minutes a day (consecutively) ·      Throw out all the simple carbs in your kitchen: all cereals and granola, use olive oil to cook and no vegetable oils, Processed dry food in boxes or cans should be donated to charity. ·      Buy fresh fruit, fresh vegetables, cheese yogurt, fresh or frozen meat, fish chicken, turkey for meals at home. ·      Sourdough bread is the best choice in breads—it has no gluten but still has carbohydrates, so small amounts are advised. ·      Do something you love every day ·      Look for opportunities to have fun You CAN turn your bad genes off through a healthy lifestyle!  Now we know even your genes can be combatted through healthy living. The diseases of aging can be adjusted or avoided.  When thinking about what your risks might be, remember that Family history is a broad and faulty way to determine your risk, but genetic testing is a better way to determine your risk of disease that is found in in your chromosomes and genes. The combination of your genes are uniquely yours. Knowing what your genes are can guide you to an individual healthy lifestyle for avoiding disease and living a long life.   We offer this service for our patients who want to know what the perfect diet and lifestyle plan is.  It is called the   Nutrigen test is optional but a great idea if you are trying to renovate your life! This saliva test (no needles) can determine the genetics you inherited from your ancestors.  We then share the information with you and develop a lifestyle plan that includes lifetime changes in eating to decrease carbohydrates from grains and sugar, increase protein, and remove as many processed foods as possible. The Nutrigen test tells you what genes you inherited that impacts your health, but it doesn't tell me whether you have turn any of your bad genes off or your bad genes on! We offer that test to our patients who are trying to lose fat or just reframe their life so they can live more productively and as much without disease as possible, Now if you aren't convinced that you need to replace your hormones with testosterone plus estradiol if you are a postmenopausal woman, or if you figure you will   Does a future of having Alzheimer's disease strike your panic button enough to change what you eat and how much you exercise, and to replace your Testosterone with Pellets?  Or is it losing a limb from diabetes? Being unable to talk from a Stroke?  Would losing your ability to move around as you do today from a Stroke or heart attack make you scared enough to value your health and clean up your lifestyle?  Or would the prospect of never having sex again be the trigger that causes you to be as careful with you own health, body,  and mind, preserving it for the rest of your life? Medical care is not just about fixing the sick through medications or surgery anymore, although that is the paradigm we have all grown up in.  That dated belief may have dominated our  belief  about what medical care can do for us and how it works because until recently medical experts didn't understand how diseases sprouted from a bad lifestyle, or because we were taught that our genes determine our health and there is nothing we can do about it…..but we now know that leading a healthy lifestyle, using food as fuel and not entertainment, and being moderate in everything from food, to alcohol to exercise is the key to a long healthy life. New information in the last 20 years has come to light  revealing that an individual can turn off bad genes through a healthy lifestyle…. Your genetics do not  dictate your fate, but it is your behavior that dictates the diseases you will suffer fromwith through the last half of your life  and eventually die from. Let's talk about the most dangerous lifestyle choices that you can make. You must think about your body as a luxury car that requires a lot of maintenance, the best quality gas to fuel it, and loving care every day to maintain its value and performance.  Our bodies are a thousand times more complicated than the highest- performance car, and I contend that the most beneficial maintenance you can do is to think about your health every day especially when you are presented with behavioral choices.  For instance, when you wake up you should stretch and make sure your muscles are not spasmed.  YThe you should think about the two most important choices you will make all day, “When will I work out for an hour?” and “What shall I eat today?”. .  Exercise is key to managing your insulin sensitivity and blood sugar, protecting you from diabetes and heart disease.  Why would you avoid this inexpensive protection from these deadly diseases?   Planning what you will eat that day (or for the next week) should include  healthy, non-processed foods and drinks with plenty of water and protein and limited carbohydrates from grains especially from wheat. But you counter my suggestion ,” Wwhat should I do when everyone around me is overeating processed foods and drinking alcohol and sugared soda?”.  My answer is, “Stop and think! Do you drive over a cliff because the guy in front of you does? No!  Be brave and don't make a scene., just choose to eat and drink in a healthy manner…if that is not available, leave and find the food and drink your body needs!”  You are no longer a teenager when all the mistakes we make are “forgiven” by our bodies.  That stops working after age 20!   I think you should look at taking care of yourself like being engaged in working toward a goal, whether it be in sports, climbing the corporate ladder, getting a raise or getting your degree.  Health is a goal that will repay you throughout your life. I no longer work in OBGYN not because I didn't enjoy it, or it wasn't profitable enough, I stopped running around with my hair on fire, stressed out and exhausted without adequate sleep or nutrition because it was bad for me!  My medical practice literally made me sick!  I gained weight, felt terrible, looked old, was crabby and depressed, so I made a choice to make my health a priority and a priority for my patients. In terms of how  my medical practice changed…from doing insurance paid medicine which is paid for the patient by someone else I was daily faced with patients who didn't value my advice and didn't follow it!  I now have a medical practice where patients pay for their care themselves.  There is something about paying for something that makes you value it more! Instead of seeing patients yearly that I gave the same advice I give to my BioBalance patients today and repeating myself year after year without my patients making any progress, I now recommend lifestyle changes and treat my patients with replacement testosterone and estradiol pellets and they immediately feel better and follow my advice! I am blessed to watch my patients achieve health by changing their hormones, diet, exercise, changing medications and taking supplements to round out the nutrition offered by their food choices. The one most important health goal should be weight loss so you can achieve your ideal weight while you maintain your muscle mass. That change will take effort and sacrifice and if you are over 40 you will need testosterone to make this happen!    Here are the diseases that are caused by obesity: ·      CANCER! All kinds! ·      Diabetes-Type II ·      Heart disease, Myocardial infarction and stroke ·      Alzheimer's disease ·      Autoimmune diseases ·      Endometriosis ·      Arthritis and joint replacement ·      Hypertension and kidney disease ·      Immune deficiency Are you afraid of getting any of these diseases?  What is your most terrifying disease that keeps you awake at night?  Any of these in the list above?   I have always been fearful of Alzheimer's Disease and stroke because not being able to think and speak is my biggest fear!  I have gone so far as to have genetic tests for Alzheimer's Dx and I have 1 of the 2 genes that cause this devastating condition. However, because I have taken estradiol and Testosterone pellets since I was 47, my chance of getting this disease has been delayed 20 years.  Other factors that increase my risk for stroke and dementia are inflammation from being overweight, eating a high carb diet, lack of exercise, hypertension, poor neurotransmitters from a poor diet and bad gut bacteria.  One by one I have changed my lifestyle to decrease these risk factors. If I can do this, you can!  You don't have a harder work schedule than I have had or less time to choose foods to eat.  I choose to turn down more than one alcoholic beverage, to take my own healthy snacks when I travel and at my office. 

In this week's episode we'll discuss how immune fitness impacts response to teclistamab in relapsed/refractory multiple myeloma; learn more about a new mechanism of resistance to asciminib conferred by the BCR::ABL1 M244V mutation, and discuss the impact of hematopoietic cell transplantation on myocardial fibrosis in young patients with sickle cell disease. Featured Articles:Correlation of immune fitness with response to teclistamab in relapsed/refractory multiple myeloma in MajesTEC-1BCR::ABL1 kinase N-lobe mutants confer moderate to high degrees of resistance to asciminibImpact of hematopoietic cell transplantation on myocardial fibrosis in young patients with sickle cell disease

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

This is pretty cool! I'm using our platform to share a bit of great info in real time as it unfolds. If you subscribe or follow the podcast, you'll get these occasional Imperfect Heart Info-pods to make announcements on things that affect us in some way or another. You'll see them as well on YouTube. Here's what this Info-pod is all about. Imagine the power of sharing your journey with someone who truly gets it. That's the magic we're bringing to life with this first ever Myocardial Bridge Meetup! Scheduled for September 14th, 2024, in downtown Sacramento, California, this event is more than just a gathering—it's a chance for our community to connect, support, and uplift one another. Whether you're navigating the complexities of your condition or celebrating post-surgery milestones, you'll find a safe space to ask candid questions, share your experiences, and forge lasting bonds. I'm also hoping for a virtual discussion with one of doctors we've previously interviewed, adding even more value to our meetup. If you're within driving distance, downtown Sacramento offers a convenient and accessible location with plenty of nearby accommodations. Remember, space is limited, so register quickly for the benefit of knowing our attendance. For any questions, head to our website (My Imperfect Heart Website) and click the contact tab. Let's make this inaugural Myocardial Bridge Meetup an unforgettable experience for our community, and continue to change the way the medical world views our condition. Cheers to our imperfect hearts! Meet others in similar situations as yourself and have candid conversations about the condition Hear stories from those who have been where you are Hear from spouses and significant others who have experienced a loved on with a bridge Meet others who are active on the Facebook page that may have become trusted sources Thanks and I'm looking forward to meeting you all! Here are all the registration details: Imperfect Heart Coronary Kingdom Meetup

Commentary by Dr. Candice Silversides and Dr. Leslee J. Shaw

Can personal experiences with heart disease shape the future of heart surgery? Join me as I sit down with Dr. Danny Ramzy, a groundbreaking minimally invasive heart surgeon, to unravel his inspiring journey in medicine. Driven by his family's history with heart disease, Dr. Ramzy transitioned from classical training to becoming a pioneer in robotic heart surgery. He recounts his first encounter with robotic techniques during his fellowship and how these innovations have revolutionized procedures like unroofing myocardial bridges, offering patients faster recoveries with minimal life disruption. What makes robotic surgery a game-changer in treating myocardial bridges? The conversation shines a spotlight on the meticulous techniques Dr. Ramsey employs to free arteries from muscle encasement and the complexities involved with smaller arteries. We delve into the choice between traditional sternotomy and robotic approaches, underscoring the pivotal role of surgical experience. Dr. Ramsey also introduces us to the latest advancements in robotic surgery, including haptic feedback, which enhances precision and safety, making these procedures more effective than ever. How do we differentiate between benign intramyocardial vessels and pathological myocardial bridges? Our discussion delves into the essential diagnostic protocols and personalized treatments necessary for optimal patient outcomes. Dr. Ramsey clarifies the significant benefits of surgical unroofing for symptomatic patients and highlights the ongoing advancements at McGovern Medical School at the University of Texas Health in Houston. We'll wrap the episode by acknowledging the vibrant myocardial bridge community and Dr. Ramsey's unwavering dedication to improving patient care and outcomes. To reach Dr. Ramzy's office you can call 713-486-6690 and schedule an appointment for a consultation. Episode Highlight Timestamps (03:21 - 05:18) Robot-Assisted Unroofing for Myocardial Bridges (13:10 - 14:06) Endovascular Unroofing of Arteries (18:11 - 21:55) Myocardial Bridge Unroofing Importance (25:44 - 26:48) Global Advancements in Robotic Surgery (28:39 - 29:53) Consultation Process for Robotic Surgery Episode Chapter Summaries (00:00) Minimally Invasive Heart Surgery Innovations. Dr. Ramzy's journey to becoming a minimally invasive heart surgeon, influenced by family experiences and technology, and his use of robotics for unroofing myocardial bridges. (12:11) Robotic vs. Minimally Invasive Surgery. Unroofing myocardial bridges in LAD artery, considering surgical approach and advancements in robotic surgery for precision and safety. (18:35) Advancements in Robotic Heart Surgery. Myocardial bridges are complex and often misunderstood, but surgical unroofing can benefit symptomatic patients. (29:49) Sharing Stories of Myocardial Bridge. Facebook group supports patients with myocardial bridge, emphasizing accurate diagnosis and ongoing efforts to understand and treat the condition.      

Could your heart be sending distress signals that traditional tests can't detect? Join me, Jeff Holden, for a revealing conversation with Dr. Samit Shah from Yale School of Medicine as he shares groundbreaking insights on the Discover INOCA research program. This multicenter study is pioneering the way we understand ischemia and non-obstructive coronary arteries (INOCA), focusing on elusive conditions like coronary microvascular dysfunction, myocardial bridging, and coronary vasospasm. Collaborating with institutions such as Stanford and Columbia University, this research aims to establish standardized protocols for better patient outcomes through advanced diagnostic techniques. And meet David Tretter, a patient whose life took a dramatic turn due to severe heart arrhythmias. His journey from a terrifying heart arrhytmia that led to a game-changing diagnosis at Yale is nothing short of inspiring. Dr. Shaw and his team meticulously differentiated David's myocardial bridge from his arrhythmias, using comprehensive tests like angiograms and provocative testing. Their collaborative effort underscores the importance of precision in diagnosis, ultimately leading to effective treatment and a significant improvement in David's quality of life. The road to recovery doesn't end with diagnosis. Discover the transformative power of cardiac rehabilitation through David's experience at Lawrence Memorial. Dr. Shaw emphasizes the critical role of cardiac rehab in helping patients regain physical fitness and confidence. The episode also ventures into the broader challenges of diagnosing persistent cardiac symptoms, advocating for continued innovation and collaboration in heart health research. This episode demonstrates the importance of patient-doctor relationships and the ongoing quest for better heart health solutions from today's medical care teams. To learn more about the clinical trials of Discover INOCA visit: https://medicine.yale.edu/ycci/trial/the-discover-inoca-prospective-multi-center-registry/ Episode Highlights (00:08 - 00:48) Discover INOCA Research Program (06:26 - 07:47) Identifying Myocardial Bridge (11:10 - 12:24) Treatment Plan for Myocardial Bridge Symptoms (15:48 - 17:43) Recovery Success After Surgery (21:12 - 22:34) Advantages of CAT Scans in Diagnosis (27:59 - 29:15) The Challenge of Diagnosing Myocardial Bridges Chapter Summaries (00:00) Discover INOCA Research Program Overview Discover INOCA is a collaborative research program investigating INOCA, using advanced diagnostic techniques to improve patient outcomes. (06:31) Heart Condition Diagnosis and Treatment David's journey from severe heart arrhythmias to identifying and treating a myocardial bridge, with a focus on the diagnostic process and collaborative effort among medical professionals. (16:26) Cardiac Recovery and Rehabilitation Regaining physical fitness post-cardiac surgery through structured cardiac rehab and identifying and treating coronary bridges. (20:18) Chronic Symptoms and Diagnostic Challenges Evolving technology and comprehensive workups aid in diagnosing and treating persistent cardiac symptoms, as seen in David's case. (27:59) Patient-Doctor Relationship and Heart Research Myocardial bridges, patient frustration, advanced testing, groundbreaking research, patient-doctor communication, and collaboration for better outcomes.  

Can a legal case become a catalyst for groundbreaking medical research? In this episode, I sit down with Dr. Ingela Schnittger, a trailblazer in the field of cardiology, as she recounts how a tragic courtroom moment ignited her passion and led her to a pivotal collaborative effort at Stanford. Dr. Schnittger explains the complexities of myocardial bridges and the vital role a multidisciplinary team plays in accurately diagnosing and treating this often-misunderstood condition. You'll gain insights into the significance of combining expertise from cardiologists, radiologists, and surgeons to tackle the intricacies of this cardiac anomaly. We'll touch on the latest technology in myocardial bridge treatment and the meticulous surgical interventions pioneered at Stanford. Dr. Schnittger shares the precision required in preoperative evaluations and the importance of thorough diagnosis to ensure successful surgical outcomes. We delve into the potential widespread prevalence of myocardial bridges and their significant impact on cardiac events, emphasizing the need for expert care and comprehensive preoperative mapping for proper diagnosis. Dr. Schnittger's discussion underscores the critical role of experience and dedication within the surgical team at Stanford, highlighting their exceptional track record over the past 10+ years. We'll close with the patient-centric process of cardiac rehabilitation and recovery, crucial for post-surgery. Dr. Schnittger offers valuable guidance on structured rehab programs, medication management, and the importance of a gradual return to normal activities. We also touch on the importance of family medical history in diagnosing and managing heart conditions. Concluding with a heartfelt exchange of gratitude and appreciation, this episode underscores the profound impact of Dr. Schnittger's work on countless lives. If you've just been diagnosed, or believe you need to get properly diagnosed to identify or eliminate the possibility of a myocardial bridge, this conversation will give you everything you need to take the next steps with your cardiologist. If you know of someone suffering from undiagnosed chest pain, angina or heart attack like symptoms, please share this episode with them. If you have a doctor or worse yet, cardiologist that is uncertain of the impact of a myocardial bridge, or possibly doesn't accept them as symptomatic at all, be certain to share this episode with them. Share all the episodes with them.  As always, stay positive and grateful. There's hope for what it is you're going through. For more information, visit www.myimperfectheart.com Chapter Summaries (00:00) Understanding Myocardial Bridges and Treatment Dr. Schnittger discusses his journey into myocardial bridges, the importance of a multidisciplinary team, and advancements in surgical intervention. (18:42) Advancements in Myocardial Bridge Treatment Myocardial bridge treatment at Stanford involves precise preoperative evaluations and a dedicated surgical team with a successful track record. (34:32) Myocardial Bridge Diagnosis and Treatment Stepwise approach to treating myocardial bridges with medications, surgery if needed, and advancements in non-invasive diagnostic tools. (50:21) Cardiac Rehab and Recovery Guidance Cardiac rehab for endothelial dysfunction and myocardial bridges, importance of structured programs and gradual recovery, managing professional stress, and proactive family medical history. (57:25) Gratitude for Benefactor and Speaker Host expresses gratitude for Dr. Schnittger's positive impact, while Dr. Schnittger regrets not meeting in Stanford but is happy to see the host thriving.    

With Juerg Schwitter, Ambra Masi &  Panagiotis Antiochos, University Hospital Lausanne, Lausanne - Switzerland. Link to editorial Link to paper

In this episode, I attempt to reveal some lesser known truths of myocardial bridges as I unravel the complexity of heart-related symptoms that often go misdiagnosed. You'll gain a deeper understanding of the disparity between the prevalence of this condition and the surprisingly low number of patients who receive accurate diagnoses. Did you know one-in-four of us is likely to have a myocardial bridge? How many people may actually be dying as a result of an undiagnosed bridge? Amidst the statistics that paint heart disease as the leading cause of death, I'll shed some light on the silent battles many face with undiagnosed chest pain, shortness of breath, and the emotional toll of not knowing. This episode is meant to outline and guide those affected or suffering from chest pain or shortness of breath or chronic fatigue towards recognizing the proper signs and advocating for themselves in a healthcare landscape that can sometimes overlook such crucial ailments. With options ranging from traditional sternotomy to state-of-the-art robotic surgery for "unroofing" a myocardial bridge, guests have shared their personal anecdotes of navigating these decisions and the life-changing moments post-surgery. With myself included, we're all testament to the fact that the surgery does benefit us and it needs to be more accessible for those in need. Let the "cycle to diagnosis" support you in your journey giving you a list of action items that should lead you to your resolution of the condition or at the very least a proper diagnosis of your condition. I have no doubt proper diagnosis of a myocardial bridge saves lives through the ripple effect of heightened recognition and medical progress.

N Engl J Med 2014;371:1016-1027Background: Prior trials have demonstrated that combining P2Y12 inhibitors with aspirin in patients with acute coronary syndrome reduces cardiovascular events. Prasugrel, in the TRITON-TIMI 38 trial, and ticagrelor, in the PLATO trial, were administered in the hospital.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Older trials had suggested that early administration of glycoprotein IIb/IIIa inhibitors improves outcomes in patients with ST elevation myocardial infarction (STEMI).The ATLANTIC trial sought to test the hypothesis that pre-hospital compared to in-hospital administration of the P2Y12 inhibitor, ticagrelor, improves outcomes in patients with STEMI.Patients: Patients were enrolled if they had STEMI and had experienced symptoms for at least 30 minutes but no longer than 6 hours, and were expected to have EKG to balloon inflation of less than 120 minutes. Patients were excluded if they had prior intracranial bleeding, moderate to severe liver disease, gastrointestinal bleeding within 6 months, planned fibrinolytic therapy or required dialysis.Baseline characteristics: The average age of patients was 61 years with 80% being men. The average weight was 80 kg. About 14% had diabetes, 9% had prior myocardial infarction, 4% had chronic obstructive pulmonary disease and 2% had chronic renal failure. TIMI risk score was 0-2 in 61% of the patients. About 90% had Killip class I. Coronary angiography was performed in 98% of the patients and percutaneous coronary intervention (PCI) with stent placement was performed in 82%. The use of glycoprotein IIb/IIIa inhibitors was high in the study and was administered before percutaneous coronary intervention in 29% of the patients.Procedures: Patients were randomized 1:1 to receive ticagrelor en route to the hospital/ catheterization lab (group 1) or at the catheterization lab (group 2). In group 1, patients received ticagrelor 180mg en route to the hospital and placebo in the catheterization lab. In group 2, patients received placebo en route to the hospital and ticagrelor 180mg in the catheterization lab. Following that, all patients received ticagrelor 90mg twice daily for at least 30 days and the treatment was recommended to continue for 12 months. Clinical endpoints were adjudicated up to 30-days post randomization.Endpoints: There were two coprimary endpoints – proportion of patients who did not have 70% or greater resolution in their ST-segment elevation before PCI and proportion of patients without TIMI grade III flow in the infarcted artery before PCI. Review of EKG and angiographic data was blinded.A secondary prespecified endpoint included the composite of all-cause death, myocardial infarction, stent thrombosis, stroke or urgent revascularization at 30 days.Analysis was performed based on the modified intention-to-treat principle, defined as patients who received at least one loading dose of the study drug. Patients with missing EKG or angiographic data were excluded from the primary endpoint analysis.The sample size estimate was based on an anticipated event rate of 15% in the control group for the EKG endpoint. They estimated that 779 patients would be needed in each group to show a 6% absolute difference with 80% power and an alpha of 2.5%.Results: The trial randomized 1,862 patients, 909 patients to the prehospital group and 953 to the in-hospital group. The median time from randomization to angiography was 48 minutes and the median time between the two loading doses was 31 minutes.There was no significant difference in the proportion of patients who did not have 70% or more ST segment resolution before PCI (86.8% for the pre-hospital group vs 87.6% for the in-hospital group, OR: 0.93, 95% CI: 0.69 – 1.25; p= 0.63) or the proportion of patients who did not have TIMI III flow in the infarcted artery before PCI (82.6% for the pre-hospital group vs 83.1% for the in-hospital group, OR: 0.97, 95% CI: 0.75 – 1.25; p= 0.82).There was also no significant difference for the secondary composite endpoint (4.5% vs 4.4%, OR: 1.03, 95% CI: 0.66 – 1.60; p= 0.91). Stent thrombosis at 30-days was lower in the pre-hospital group (0.2% vs 1.2%, OR: 0.19, 95% CI: 0.04 – 0.86; p= 0.02). Myocardial infarction was not significantly different between both groups (0.8% vs 1.1%; p= 0.53). All-cause death was numerically higher in the pre-hospital group (3.3% vs 2.0%, OR: 1.68, 95% CI: 0.94 – 3.01; p= 0.08).Major bleeding not related to CABG was not significantly different between both treatment groups (1.3% in both groups using the TIMI criteria and 2.9% in the pre-hospital group vs 2.5% in the in-hospital group, using the STEEPLE criteria).Conclusion: In patients with STEMI, pre-hospital administration of ticagrelor did not improve outcomes compared to in-hospital administration. Although pre-hospital administration of ticagrelor reduced stent thrombosis at 30-days, this did not reduce all-cause mortality. In fact, all-cause mortality was numerically higher in the pre-hospital group.A notable finding is that within the in-hospital group, definite stent thrombosis occurred in 1.2% of patients while 1.1% were adjudicated to have myocardial infarction. Stent thrombosis is a serious condition that leads to myocardial infarction. The trial protocol used many definitions for myocardial infarction. This underscores the complexity of counting and adjudicating events in clinical trials and highlights the importance of relying on outcomes less susceptible to bias, such as mortality.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

JAMA. 2013;309(12):1241-1250Background Case reports as early as the 1950s suggested chelation of lead might reduce angina. The popularity of chelation accelerated around the turn of the century. Small underpowered trials of chelation were inconclusive. Mainstream medicine considered chelation unproven and potentially hazardous.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Chelation with disodium EDTA binds divalent and some trivalent cations, including calcium, magnesium, lead, cadmium, zinc, iron, aluminum, and copper, which facilitates their urinary excretion. High dose vitamins are often co-administered with chelation.The NIH-funded Trial to Assess Chelation Therapy (TACT) trial was conducted to respond to the public health problem posed by EDTA chelation therapy: namely, that large numbers of patients could be exposed to undefined risks for unproven benefits. TACT was a double-blind placebo-controlled 2x2 factorial randomized trial enrolling 1708 patients to test chelation therapy.Patients Eligibility for TACT required patients be older than 50 years, have a creatinine of < 2 mg/dl, and have survived a previous myocardial infarction. Exclusion criteria included platelet count less than 100 000/μL, abnormal liver function, BP > 160/100 mm Hg, past intolerance to the chelation or vitamin components, chelation therapy within 5 years, coronary or carotid revascularization planned or having taken place within 6 months, cigarette smoking within 3 months, active heart failure or heart failure hospitalization within 6 months, or inability to tolerate 500-mL infusions weekly. Enrollment began in 2003 and follow-up continued until 2011. There were 134 sites; 60% of which were established chelation centers.Baseline Characteristics The median age of patients was 65 years, 18% were women and the median body mass index was 30. More than 90% of patients had had either percutaneous coronary intervention or coronary bypass surgery. Approximately 31% of patients had diabetes. Use of guideline directed medications was typical of a well-treated population of post-MI patients. Procedures The active 10-component chelation solution consisted of up to 3 g of disodium EDTA; 7 g of ascorbic acid; 2 g of magnesium chloride; 100 mg of procaine; 2500 U of unfractionated heparin; 2 mEq of potassium chloride; 840 mg of sodium bicarbonate; 250 mg of pantothenic acid; 100 mg of thiamine; 100 mg of pyridoxine; and sterile water to make up 500 mL of solution. The identical-appearing placebo solution consisted of 500 mL of normal saline and 1.2% dextrose (2.5 g total).The chelation or placebo infusions were administered through a peripheral intravenous line, weekly for the first 30 infusions, followed by an additional 10 infusions 2 to 8 weeks apart. Patient also received an oral vitamin-mineral regimen vs an oral placebo. In this review, we focus on the intention-to-treat comparison of EDTA chelation vs placebo.Endpoints The primary endpoint was a composite of death, reinfarction, stroke, coronary revascularization, or hospitalization for angina.TACT trialists had planned to enroll 2300 patients over three years with a follow-up of one year. Enrollment was slow, and with permission from the data safety monitoring board (DSMB) enrollment was decreased to 1700 patients and follow-up was extended. The resultant power was 85% to detect a 25% reduction in the primary endpoint assuming a 2.5% per year event rate in the placebo arm.Over the course of the trial, the DSMB requested 11 interim analyses of the data. Because of the increased monitoring, the level of statistical significance required for the primary endpoint was enhanced to a P value of less than 0.036.Results After a median follow-up of 55 months, a primary end point occurred in 222 (26%) of the chelation group and 261 (30%) of the placebo group (hazard ratio [HR]: 0.82 [95% CI: 0.69-0.99]; p= .035). There was no effect on total mortality (10% vs 11%, HR: 0.93, 95% CI: 0.70-1.25; p= 0.64). Myocardial infarction and coronary revascularization favored chelation (6% vs 8% and 15% vs 18%, respectively), however this did not reach statistical significance for either endpoints.Subgroup analysis revealed a potentially important heterogenous treatment effect. In patients with diabetes (about a third of patients) there was an approximate 40% reduction in the primary endpoint (HR: 0.61, 95% CI: 0.45-0.83; p= 0.002).There were no significant differences in adverse effects between the two groups.The trialists did sensitivity analyses centering on patients who withdrew from the trial or were lost to follow-up. The comparison of the 2 groups remained significant even if the percentage of events among withdrawn/lost patients in the active group was 25% higher than in the placebo group.Conclusions The results of the TACT trial surprised the cardiology community. Prior beliefs were pessimistic because heavy metals was not a proven causal factor in atherosclerosis. What's more, the majority of patients were enrolled from non-traditional medical centers.Yet the effect size was both clinically important and statistically significant. The effect size in the diabetes subgroup, which was pre-specified, was even larger and more robust statistically than the general results. In fact, there was essentially no signal of benefit from chelation in non-diabetic patients. If this was confirmed, it would be a major finding both therapeutically and scientifically, as it would have discovered heavy metal exposure as an important cause of atherosclerosis.The Journal of the American Medical Association published the manuscript along with an explanatory letter from the editors, and an accompanying editorial from Dr. Steve Nissen, which challenged the internal validity of the trial.The results of TACT did not lead to widespread adoption of chelation, but it did lead primary investigator Gervasio Lamas to seek (and obtain) funding for a TACT 2 trial to study chelation in patients with diabetes. Experts often refer to subgroup findings as “hypothesis-generating” and so it was with the TACT 1 and TACT 2 trials.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Commentary by Brian Jensen

My own heart skipped a beat upon hearing Dr. Peggy DeLong's tales of loss and fear. Peggy, a beacon of resilience, opens up about the profound losses that shaped her life—her fiancé and her father both taken too soon; Her father by a heart condition, her fiance by cancer. Her very own terrifying brush with what she feared was a heart attack rekindled her commitment to gratitude, a practice she has long championed. The power of embracing gratitude to replace fear is exemplified as Dr. DeLong discusses strategies to counterbalance fear, stress and anxiety for us, especially during the emotionally charged holiday season. We examine the shared exercise of "team gratitude," where partners enrich their connection by daily acknowledgments of appreciation, and explore how gratitude can serve as a compass to steer us away from the shadows of fear. Peggy's insights on the delicate dance between honoring our fears and not allowing them to consume us are a testament to the strength that comes from vulnerability and her belief that we cannot truly experience joy without having first gone thru the fear or pain of a situation. As festive lights twinkle, reminding us of the joys and challenges the holiday season brings, I hope this episode brings a gift or understanding of a practice we all can use to relieve some of the pressure, anxiety and fear of the unknown we may be dealing with. Peggy's journey reminds us all of the small steps we can take towards maintaining hope, and the profound impact a simple act of gratitude can have on our lives. If the fear is particularly distracting at any given time, why not buy a stranger, well... a cup of hazelnut coffee? I am personally grateful for all of you, my family of "Imperfect Hearts", that are doing what you must to get your symptoms relieved, advocating for yourself and helping others along the way.  Have a blessed holiday season with friends and family and here's to a happy, healthy and prosperous new year in 2024.  From the bottom of my Imperfect Heart, Thank you. For more information on Myocardial Bridges, visit www.myimperfectheart.com

Commentary by Dr. Valentin Fuster

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Doctor Warrick Bishop discusses heart disease risks and prevention on his podcast. He talks about an interesting presentation he saw on myocardial bridging, where the coronary artery runs through the heart muscle in 20% of people. This was thought to not impact blood flow, but can in rare cases limit flow and cause angina symptoms. This is a cause of MINOCA syndrome, where ischemia occurs despite clear arteries. Doctor Bishop describes diagnostic tests like CT scans and intravascular ultrasound to identify bridging arteries. Surgery called deroofing can be done to free up a compressed artery. Medications may also help symptoms but stents are unlikely to. The podcast highlights this potential new cause of angina symptoms from a rare arterial variation.

Contributor: Dylan Luyten MD Educational Pearls: What is a Bradyarrhythmia? Also known as a bradyarrhythmia, it is an irregular heart rate that is also slow (below 60 beats per minute). What can cause it? Complete heart block AKA third-degree AV block; identified on ECG by a wide QRS, and complete dissociation between the atrial and ventricular rhythms with the ventricular being much slower. Treat with a pacemaker. Medication overdose, especially beta blockers. Many other drugs can slow the heart as well including: opioids, clonidine, digitalis, amiodarone, diltiazem, and verapamil to name a few. Electrolyte abnormalities, specifically hyperkalemia. Hypokalemia, hypocalcemia, and hypomagnesemia can also cause bradyarrhythmias. Myocardial infarction. Either by damaging the AV node or the conduction system itself or by triggering a process called Reperfusion Bradycardia. Hypothermia. Bradycardia is generally a sign of severe or advanced hypothermia. References Jurkovicová O, Cagán S. Reperfúzne arytmie [Reperfusion arrhythmias]. Bratisl Lek Listy. 1998 Mar-Apr;99(3-4):162-71. Slovak. PMID: 9919746. Simmons T, Blazar E. Synergistic Bradycardia from Beta Blockers, Hyperkalemia, and Renal Failure. J Emerg Med. 2019 Aug;57(2):e41-e44. doi: 10.1016/j.jemermed.2019.03.039. Epub 2019 May 30. PMID: 31155316. Wung SF. Bradyarrhythmias: Clinical Presentation, Diagnosis, and Management. Crit Care Nurs Clin North Am. 2016 Sep;28(3):297-308. doi: 10.1016/j.cnc.2016.04.003. Epub 2016 Jun 22. PMID: 27484658. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII