POPULARITY
4 episodes with paroxysmal
6 episodes with paroxysmal
6 episodes with paroxysmal
6 episodes with paroxysmal
3 episodes with paroxysmal
2 episodes with paroxysmal
3 episodes with paroxysmal
2 episodes with paroxysmal
2 episodes with paroxysmal
This week we will discuss possible treatment methods for AFIB. Atrial fibrillation (AFib) is a common type of irregular heart rhythm (arrhythmia) that occurs when the upper chambers of the heart (atria) beat chaotically and out of sync with the lower chambers (ventricles). This can lead to a variety of symptoms, including: Palpitations (a feeling of a racing or irregular heartbeat) Fatigue Shortness of breath Dizziness or lightheadedness Chest discomfort AFib can increase the risk of blood clots, stroke, heart failure, and other heart-related complications. Treatment Options for AFib Management of AFib focuses on controlling the heart rate and rhythm, preventing blood clots, and addressing underlying conditions contributing to the arrhythmia. The choice of treatment depends on the individual's symptoms, overall health, and risk factors. 1. Medications Medications are often the first line of treatment for AFib. These include: Rate-Control Medications Aim to slow the heart rate to a normal range. Common drugs: Beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., diltiazem, verapamil), and digoxin. Rhythm-Control Medications Help restore and maintain a normal heart rhythm. Common drugs: Antiarrhythmics like amiodarone, flecainide, or sotalol. Anticoagulants (Blood Thinners) Reduce the risk of stroke by preventing blood clots. Examples: Warfarin, direct oral anticoagulants (DOACs) like apixaban (Eliquis) or rivaroxaban (Xarelto). 2. Ablation Therapy Ablation is a minimally invasive procedure aimed at correcting the electrical signals causing AFib. It is typically recommended for individuals who: Do not respond to or cannot tolerate medications. Have recurrent or persistent AFib that significantly impacts quality of life. Types of ablation: Catheter Ablation Uses thin tubes (catheters) inserted into blood vessels to deliver energy (radiofrequency or cryotherapy) to destroy small areas of heart tissue causing abnormal electrical signals. Surgical Ablation (Maze Procedure) Often performed during open-heart surgery for other conditions, creating scar tissue to block abnormal signals. Both options have high success rates, but catheter ablation is more commonly performed due to its minimally invasive nature. Choosing the Right Treatment Deciding between medications or ablation depends on factors such as: The severity and frequency of symptoms. The presence of other medical conditions. Patient preference and lifestyle. Consultation with a cardiologist or electrophysiologist is crucial to tailor treatment to the individual's needs.
Practical Perspectives: Investigators Discuss the Current Management of Paroxysmal Nocturnal Hemoglobinuria — Jamile M Shammo, MD CME information and select publications
Featuring perspectives from Dr Gloria Gerber, Dr Jamie Koprivnikar, Prof Alexander Röth and Dr Jamile M Shammo, including the following topics: Introduction: Paroxysmal Nocturnal Hemoglobinuria (PNH) and the General Medical Oncologist Diagnosis of and myths and misperceptions about PNH (0:00) Overview — Biology and Pathophysiology Role of complement activation in PNH; classification and clinical presentation (7:00) PNH treatments and their complement targets (21:37) Current Management Approaches Mechanistic similarities and differences between crovalimab and other available C5 inhibitors; potential practical advantages of crovalimab (24:56) Timing for initiation of treatment for PNH (32:08) Management of clinically significant extravascular hemolysis and residual anemia in patients with PNH receiving C5 inhibitor therapy (43:08) Risk of evolution to aplastic anemia or myeloid malignancy (45:54) Clinical trial database establishing the efficacy and safety of the C5 complement inhibitors eculizumab and ravulizumab for PNH (48:47) Activity and safety of and clinical experience with crovalimab (53:03) Monitoring and management of PNH in pregnant patients (58:37) Case Presentations Case: A woman in her early 30s who receives a new diagnosis of classical PNH with symptomatic anemia — Dr Gerber (1:03:44) Case: A man in his early 30s with PNH initially treated with eculizumab who is transitioned to ravulizumab — Dr Koprivnikar (1:17:32) Case: A woman in her early 50s with a remote history of aplastic anemia — Dr Gerber (1:32:24) Case: A woman in her late 20s with PNH receiving active C5 inhibitor therapy who wishes to discuss alternative treatment options — Dr Koprivnikar (1:38:00) CME information and select publications
Dr Gloria Gerber, Dr Jamie Koprivnikar, Prof Alexander Röth and Dr Jamile Shammo discuss available and emerging research, patient cases from participating junior clinical investigator faculty and senior clinical investigator faculty perspectives of relevant research data informing clinical decision-making for paroxysmal nocturnal hemoglobinuria.
Dr Gloria Gerber, Dr Jamie Koprivnikar, Prof Alexander Röth and Dr Jamile Shammo discuss available and emerging research, patient cases from participating junior clinical investigator faculty and senior clinical investigator faculty perspectives of relevant research data informing clinical decision-making for paroxysmal nocturnal hemoglobinuria, moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/PNH2024/CaseRoundtable).
Welcome to Season 4, Episode 33 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Vestibular Disorders."Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses vestibular disorders, which are disorders impacting the vestibular system (responsible for balance). Join Nancy as she covers the basics of vestibular disorders, and walks through three in particular: dizziness, Meniere's Disease, and benign paroxysmal positional vertigo (known as BPPV). Even if you don't have a vestibular disorder, this episode will provide valuable insight into how disability carriers react to and handle claims based on subjective complaints.In this episode, we'll cover the following topics:1 - What You Need to Know about How Disability Carriers View Vestibular Disorder Disability Claims2 - What Are the 21 Things Your Doctor Should Address in Your Medical Records in Your ERISA Disability Claim for Dizziness?3 - What Medical Testing Will a Disability Carrier Expect in My Meniere's Disease Long-Term Disability Claim?4 - Benign Paroxysmal Positional Vertigo (BPPV) and an ERISA Disability Insurance ClaimWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Resources Mentioned In This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/FREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.
Mike, Jess and Émélie discuss Ms. Ottie Stone, a 35 year old patient who presents with dizziness. Today's podcast will discuss the diagnosis and management of benign paroxysmal positional vertigo. To claim your Mainpro+ credit on CFPCLearn, click here: https://cfpclearn.ca/?post_type=podcast&p=13750&preview=true
In this episode of Cardiology Digest, we dive into top journals like JAMA Cardiology to bring you three of the most compelling recent research papers from the field of cardiology. STUDY #1: First, see how the new Boston Scientific cryoballoon measures up against Medtronic's product. Did the newcomer outshine the veteran, or does it come with hidden risks? Discover the head-to-head results and what they mean for the future of atrial fibrillation cryoablation. Reichlin, T, Kueffer, T, Knecht, S et al. 2024. PolarX vs Arctic Front for cryoballoon ablation of paroxysmal AF: The randomized COMPARE CRYO study. JACC Clin Electrophysiol. In Press, Corrected Proof. (https://doi.org/10.1016/j.jacep.2024.03.021) STUDY #2: Next, we explore the intersection of aging, aortic stenosis, and osteosarcopenia in elderly patients undergoing transcatheter aortic valve replacement. This study highlights a radiographic method that reveals a high-risk subpopulation within this demographic. See how this insight can shape our approach to transcatheter aortic valve replacement, and what it means for patient care strategies. Solla-Suarez, P, Arif, S, Ahmad, F, et al. 2024. Osteosarcopenia and mortality in older adults undergoing transcatheter aortic valve replacement. JAMA Cardiol. 7: 611-618. (https://doi.org/10.1001/jamacardio.2024.0911) O'Gara, P, Guduguntla, V, Bonow, R, et al. 2024, Osteosarcopenia and mortality after transcatheter aortic valve replacement. JAMA Cardiol. 7: 618-619. (https://doi.org/10.1001/jamacardio.2024.1018) STUDY #3: Finally, we turn our attention to the pressing issue of hypertensive disorders in pregnancy. Discover why close postpartum monitoring is critical and what the latest research suggests about the persistence of hypertension in new mothers. Could longer follow-ups hold the key to better postpartum care? Hauspurg, A, Venkatakrishnan, K, Collins, L, et al. 2024. Postpartum ambulatory blood pressure patterns following new-onset hypertensive disorders of pregnancy. JAMA Cardiol. Published online (https://doi.org/10.1001/jamacardio.2024.1389) Join us to unravel these important studies and their implications for your practice and patients. Ready to stay ahead in the rapidly evolving world of cardiology? Hit play and let's get started! Learn more with Medmastery's courses: Holter Monitoring Essentials (2 CME) Get a Basic or Pro account, or, get a Trial account. Show notes: Visit us at https://www.medmastery.com/podcasts/cardiology-podcast.
In this episode, we review the high-yield topic of Benign Paroxysmal Positional Vertigo (BPPV) from the Ear, Nose, & Throat section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief
Title: What is Paroxysmal Sympathetic Hyperactivity? Target Audience This activity is directed to physicians who take care of hospitalized children, medical students, nurse practitioners, and physician assistants working in the emergency room, intensive care unit, or hospital wards. Objectives: Upon completion of this activity, participants should be able to: 1. Review the name changes that have occurred for Paroxysmal Sympathetic Hyperactivity (PSH). 2. Review the current definition and symptomatology of PSH. 3. Review treatment and management of PSH. Faculty: Planning Committee: Allison Williams MD, — Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh Course Directors: Tony R. Tarchichi MD — Associate Professor, Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC.) Paul C. Gaffney Division of Pediatric Hospital Medicine Dr. Tarchichi has disclosed he was a member of the Advisory Board for meningococcal vaccine in immunocompromised patient for Sanofi Corp Scott H. Maurer, MD, FAAHPM— Professor, Department of Pediatrics & Clinical and Translational Science, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC.). Hitoshi Koshiya MD - Post Graduate Year Five Child Neurology Fellow, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC.). Conflict of Interest Disclosure: No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose. Accreditation Statement: In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The University of Pittsburgh School of Medicine designates this enduring material activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity. Disclaimer Statement: The information presented at this activity represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine. Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses. Released 5/23/2024, Expires 5/24/2027 The direct link to the course is provided below: Pediatric Hospital Medicine: Updates in Urinary Tract Infections - PHM Podcast series COMING SOON!!
Commentary by Dr. Ratika Parkash
The first of this episode's two case reports features a 62-yo man, referred from ophthalmology with a drooping eyelid, chronic coughing, and excess sweating in the face provoked by eating (1:21). An MR scan finds abnormal deposits in his brain - (link) The second report describes two patients (17:05), firstly a 70-yo man presenting with abnormal facial movements and weight loss, and secondly a 90-yo woman with abnormal movements of her right arm and leg. Routine blood tests at presentation for both patients were normal at presentation - (link) The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the April 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital. Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.
Featuring perspectives from Dr Carlos M de Castro III, Prof Alexander Röth and Dr Ilene Ceil Weitz, including the following topics: Introduction: A Paroxysmal Nocturnal Hemoglobinuria (PNH) Audio Primer for General Medical Oncologists (0:00) Biology and Current Clinical Management of PNH (36:35) Future Directions in PNH Management (55:34) Tolerability and Other Practical Considerations with Available and Emerging Treatments for PNH (1:14:26) CME information and select publications
Dr Carlos de Castro, Prof Alexander Röth and Dr Ilene Weitz summarize the biology of paroxysmal nocturnal hemoglobinuria, current treatment approaches, and practical considerations for patients with the disease, moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/PNHThinkTank2024).
Dr Carlos de Castro, Prof Alexander Röth and Dr Ilene Weitz summarize the biology of paroxysmal nocturnal hemoglobinuria, current treatment approaches, and practical considerations for patients with the disease.
Jeffrey Szer, MBBS, FRACP - The Quest for Optimal Haemolytic Control of Paroxysmal Nocturnal Haemoglobinuria
Jeffrey Szer, MBBS, FRACP - The Quest for Optimal Haemolytic Control of Paroxysmal Nocturnal Haemoglobinuria
Jeffrey Szer, MBBS, FRACP - The Quest for Optimal Haemolytic Control of Paroxysmal Nocturnal Haemoglobinuria
Jeffrey Szer, MBBS, FRACP - The Quest for Optimal Haemolytic Control of Paroxysmal Nocturnal Haemoglobinuria
This week we go through the ultimate in rare diagnoses - PNH. We talk about when to suspect it, how patients may present, and an approach to treatment and management. Bonus points if you can correctly guess how many attempts it took to pronounce "phosphatidylinositol!" Written by: Dr. Angela Dong (Internal Medicine Resident) Reviewed by: Dr. Helena Dhamko (Hematologist) & Dr. Rupal Shah (General Internist)Support the show
Paroxysmal supraventricular tachycardia (PSVT) is a sudden-onset tachyarrhythmia that can cause palpitations, chest discomfort, and dyspnea. JAMA Associate Editor David Simel, MD, MHS, discusses the diagnosis and treatment of patients with PSVT with author Paul Zei, MD, of Harvard University. Related Content: Diagnosis and Management of Paroxysmal Supraventricular Tachycardia Modified Valsalva Maneuver (video) Carotid Sinus Massage (video)
The ABMP Podcast | Speaking With the Massage & Bodywork Profession
A young client is comatose after a series of ischemic strokes. They have frequent painful episodes of paroxysmal sympathetic hyperactivity, during which their muscles become spastic and their heart rate and blood pressure rise. Their palliative care team wonders if massage therapy might help the contractures of their limbs, and the massage therapist is willing to try . . . but the results are unexpected. Resources: Neurostorming: Causes, Signs, Risks, and Treatment (2022) NewGait. Available at: https://thenewgait.com/blog/neurostorming/ (Accessed: 16 February 2024). Paroxysmal sympathetic hyperactivity - UpToDate (no date). Available at: https://www.uptodate.com/contents/paroxysmal-sympathetic-hyperactivity (Accessed: 14 February 2024). Zheng, R.-Z. et al. (2020) ‘Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury', Frontiers in Neurology, 11, p. 81. Available at: https://doi.org/10.3389/fneur.2020.00081. Verma, R., Giri, P. and Rizvi, I. (2015) ‘Paroxysmal sympathetic hyperactivity in neurological critical care', Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 19(1), pp. 34–37. Available at: https://doi.org/10.4103/0972-5229.148638. Xu, S., Zhang, Q. and Li, C. (2023) ‘Paroxysmal Sympathetic Hyperactivity After Acquired Brain Injury: An Integrative Review of Diagnostic and Management Challenges', Neurology and Therapy, 13(1), pp. 11–20. Available at: https://doi.org/10.1007/s40120-023-00561-x. Host Bio: Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com. Sponsors: Books of Discovery: www.booksofdiscovery.com Anatomy Trains: www.anatomytrains.com Elements Massage: www.elementsmassage.com/abmp MYCO CLINIC: www.myco-clinic.com Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. 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The Elements Massage brand believes massage therapists deserve a supportive team, business and marketing resources, and the chance to learn as much as they want, so many Elements Massage studios offer and reimburse continuing education on an ongoing basis. It's no surprise Elements Massage therapist and client satisfaction leads the industry. That's because from day one, the brand has kept an unmatched commitment to deliver the best therapeutic massage experiences possible for both clients and massage therapists. Elements Massage studios expects the best. So should you. If this sounds like a fit, reach out. Studios are hiring! Website: https://elementsmassage.com/ABMP Facebook: https://www.facebook.com/elementsmassage Instagram: https://www.instagram.com/elementsmassage Youtube: https://www.youtube.com/channel/UCXLHkAYMgmA6_MJ8DSEZm-A Disclaimer: Each Elements Massage® studio is independently owned and operated. Franchise owners (or their designated hiring managers) are solely responsible for all employment and personnel decisions and matters regarding their independently owned and operated studios, including hiring, direction, training, supervision, discipline, discharge, compensation (e.g., wage practices and tax withholding and reporting requirements), and termination of employment. Elements Therapeutic Massage, LLC (ETM) is not involved in, and is not responsible for, employment and personnel matters and decisions made by any franchise owner. All individuals hired by franchise owners' studios are their employees, not those of ETM. Benefits vary by independently owned and operated Elements Massage® studios. Elements Massage® and Elements Massage + design are registered trademarks owned by ETM. MYCO CLINIC stands at the forefront of natural pain relief and quality patient care. 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Benign Paroxysmal Positional Vertigo (BPPV) is the most common of the vestibular disorder, truly! BUT, it is also a form of vertigo that looks like other forms of position vertigo. Or, rather, other positional vertigo looks like BPPV. It gets confusing, you're not alone! Let's break down how to better understand your vestibular disorder, how to make sure you're getting the right positional vertigo diagnosis, and what to do if all the sudden you think you have the wrong diagnosis. If that's the case it's time for a headache specialist, always! Our favorite headache specialists (truly our favorites, not just because we are affiliates!). neurahealth.co code VERTIGODOCTOR15 Work with us: thevertigodoctorcom/register use code GROUNDED at checkout for a discount!
Welcome to the latest episode of Medmastery's Cardiology Digest, where we keep you up-to-date in the ever-evolving world of cardiology. This episode promises to be a riveting exploration of breakthrough studies! STUDY #1: First, we'll delve into a national registry study on transcatheter mitral valve repair in a population that's different from what the approval was initially based upon. We'll discuss the study's implications, as we eagerly await additional trials comparing this method to traditional surgery. Makkar, RR, Chikwe, J, Chakravarty, T, et al. 2023. Transcatheter mitral valve repair for degenerative mitral regurgitation. JAMA. 20: 1778–1788. (https://doi.org/10.1001/jama.2023.7089) STUDY #2: Next, we turn our attention to a ground-breaking study examining a standardized periprocedural management strategy using direct-acting oral anticoagulants for patients undergoing endoscopy. Given the study's complication rates and length of the anticoagulant interruption period, this novel approach may redefine standards for patients with atrial fibrillation. Hansen-Barkun, C, Martel, M, Douketis, J, et al. 2023. Periprocedural management of patients with atrial fibrillation receiving a direct oral anticoagulant undergoing a digestive endoscopy. Am J Gastroenterol. 5: 812–819. (https://doi.org/10.14309/ajg.0000000000002076) STUDY #3: Our third study puts the spotlight on the challenging mission to enhance the success rate for paroxysmal atrial fibrillation treatment. We'll explore whether wider-area ablation proved superior to standard ablation for reducing recurrence, contrast that to previous trials, and touch on what's most important when considering the reasoning behind the choice of wider-area ablation versus standard ablation. Nair, GM, Birnie, DH, Nery, PB, et al. 2023. Standard vs augmented ablation of paroxysmal atrial fibrillation for reduction of atrial fibrillation recurrence: The AWARE randomized clinical trial. JAMA Cardiol. 5: 475–483. (https://doi.org/10.1001/jamacardio.2023.0212) STUDY #4: Lastly, we dissect a study centered on epicardial ablation for patients with Brugada syndrome who are suffering from ventricular fibrillation. Could this burgeoning therapy eventually replace the current implantable cardioverter–defibrillator approach? Nademanee K et al. Long-term outcomes of Brugada substrate ablation: A report from BRAVO (Brugada Ablation of VF Substrate Ongoing Multicenter Registry). Circulation 2023 Mar 24; [e-pub]. (https://doi.org/10.1161/CIRCULATIONAHA.122.063367) Join us as we unravel the complexities and potential game-changers these studies offer, and embark on a journey to better understand the future landscape of cardiology. Tune in and learn with Medmastery's Cardiology Digest! For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.
Episode 154: Heart Failure and GDMTDr. Malave explains the four main medications that are part of the guideline-directed medical therapy of heart failure with reduced ejection fraction. Dr. Arreaza added comments and questions. Written by Maria Fernanda Malave, MD. Edits by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Brief introduction: Heart failure (HF) is a common condition that affects about 23 million people in the world, and it is estimated that 50% of cases are due to heart failure with reduced ejection fraction (HFrEF). It is a major public health concern because of the high morbidity and mortality with a 5-year survival rate of 25% after hospitalization due to HFrEF.In recent years, the management of HFrEF has evolved due to increased evidence in favor of certain medications. Guideline-directed medical therapy (GDMT) is the foundation of medical therapy for these patients, and it is the result of multiple randomized controlled trials and reviews favoring four main drug classes: 1. renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors -ACEi- and angiotensin receptor blockers -ARB), 2. evidence-based β-blockers, 3. mineralocorticoid inhibitors, and 4. sodium-glucose cotransporter 2 inhibitors -SGLT-2i-. The benefit of this therapy is mostly seen when these four groups of medications are used in conjunction. During this episode, we will provide some key elements about the prescription of these medications, but this is only an overview, and you are invited to continue learning from reputable sources.Definitions: HF is defined as the impairment of the heart to meet the metabolic demands of the body. It can be caused by multiple conditions that interfere with the filling up of the heart or conditions that prevent an effective ejection of blood out of the heart. Classification of HFrEF: Based on the EF by echocardiogram, heart failure can be classified as:Heart failure with preserved ejection fraction (HFpEF) when the EF is 50% or more.Heart failure with mildly reduced ejection fraction when EF ranges between 41-49%.Heart failure with reduced ejection fraction (HFrEF) when EF is 40% or less.GDMT: Once we make the diagnosis of HF, it is key to educate our patients and re-educate them every single visit about the importance of guideline-directed medical therapy (GDMT) and lifestyle modifications, because this can change the prognosis and exacerbation rates. Many patients think that since they are feeling well after starting GDMT they can stop it, but that's going to increase exacerbations, hospitalizations, and decrease quality of life. Key points to discuss with patients.First, discuss that GDMT are disease-modifying drugs that regulate the neurohormonal system to stop the progression of the disease. We should explain to our patients that medications should be taken despite feeling well. Also, patients should be educated about regular follow-ups and medication titration. We can even instruct our patients about increasing their furosemide dose if they observe signs of overload, such as a weight increase of 2-3 kgs in 3-4 days, tight rings, socks or bracelets, also Paroxysmal nocturnal dyspnea, dyspnea on exertion, and more. Second, lifestyle modifications such as: quit smoking and alcohol. Additionally, in general, water restriction between 1.2-1.5L daily, salt restriction (there is no official recommendation about how many grams, but in general we recommend less than 2g daily). Third, it is highly recommended to do aerobic exercise that produces mild dyspnea since this improves cardiovascular capacity and decreases hospitalization risk. Patients should be encouraged to have their annual influenza vaccine and pneumococcal vaccine according to their own immunization schedule. According to the AFP journal, in September 2022, researchers found a clinically and statistically significant reduction in all-cause mortality for patients who received an influenza vaccine right after an MI, with a number needed to treat of 50, the effectivity of the vaccine may vary by season.GDMT, groups of medications:What are the basic medications any patient with HF should be on? At least, patients should be on angiotensin receptor blockers ARBs/ACEIs and Beta-blockers. Let's keep in mind that beta-blockers should be given cautiously in cases of exacerbation, but in general low doses are safe. We also have the angiotensin receptor/neprilysin inhibitors (ARNIs), a group of medications whose representative is the combination of sacubitril/valsartan, aka Entresto®. This medication should be the target once ARBs/ACEIs are tolerated. ARBs/ACEIs/ARNIs should be discontinued in the setting of advanced CKD, with a GFR of 30 or less. This applies to other medications used in HF such as SGLT-2 and mineralocorticoid receptor antagonist (MRA, such as spironolactone/eplerenone). Remember that SGLT-2 inhibitors should be started regardless diabetes status, and BB are safe in the setting of CKD. We also have other groups that are considered safe in patients with advanced CKD such as hydralazine/isosorbide dinitrate (combined or not), which are used in African Americans whose BP and HF symptoms do not improve with maximally tolerated dose of ARBs/ACEIs + BB.Ivabradine: Let's not forget about ivabradine, which is an SA node inhibitor like BB. Patients need to meet criteria such as a maximally tolerated dose of beta-blocker, heart rate of a least 70 or more and being on normal sinus rhythm to be started on this medication. Ivabradine does not improve survival as BB do, so even though they are not contraindicated in HF exacerbation, BB are still preferred since ivabradine does not decrease mortality.Titration and follow-ups in the HF management:-ARBs/ACEIs/ARNIs should be titrated approx. Q2 weeks until the maximally tolerated dose is achieved, ARNI should be titrated up Q2-4weeks. With these medications, we should monitor BP, potassium levels and Glomerular Filtration Rate (GFR). -BB can also be titrated up Q2weeks until the maximally tolerated dose is achieved. HR, BP and signs of congestion should be observed in patients on BB. Same for hydralazine/isosorbide, with BP follow-up. -MRA, such as spironolactone/eplerenone, these meds can be added in patients who remain symptomatic despite maximally tolerated doses of “ARBs or ACEIs or ARNIs” plus Beta-blockers. For MRA, potassium level, and GFR should be monitored every 2-3 days after initiation, 7 days after titration, monthly for 3 months, and then Q3 months. To start a patient on MRA, K+ must be lower than 5.Patients with HF should be followed up at least in a 2-week interval either via telephone, telemedicine, or clinic visit to assess symptoms, vital signs, bloodwork and to perform a physical exam. Monitoring EF: After 3-6 months of the patient´s stabilization, we should reorder an echo, EKG, BNP and Basic Metabolic Panel. The ejection fraction improves in all patients after GDMT initiation and compliance, and in some patients, this improvement is very significant, so we need to reassess EF after stabilization. Comorbidities: Also, let´s keep in mind that most of the patients have associated comorbidities such as Afib, diabetes, valve disease, or anemia. These comorbidities must be addressed either by starting anticoagulation, adjusting anti-diabetes medications, starting iron, or referring to cardiology if a valve replacement is needed.When to refer to Cardiology? Some patients will qualify for device therapy (ICD) as a primary prevention for ventricular arrhythmias that can degenerate either into torsades or ventricular fibrillation. These patients must be symptomatic, at least in 3 months of maximally tolerated GDMT, and EF between 30-35%. Symptomatic
Commentary by Dr Koji Miyamoto
Commentary by Dr. Edward Gerstenfeld
Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Dhiraj Gupta, MBBS, MD, of Liverpool Heart and Chest Hospital, and Tina Baykaner, MD, MPH, of Stanford University, to discuss same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071) https://www.hrsonline.org/education/TheLead Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx Contributor Disclosure(s): D. Gupta: Honoraria/Speaking/Consulting Fee: Abbott, Abbott Medical; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc., Medtronic Bakken Research Center T. Baykaner: Research (Contracted Grants for PIs Named Investigators Only): NIH
Featuring perspectives from Dr Carlos M de Castro, including the following topics: Biology of paroxysmal nocturnal hemoglobinuria (PNH) (0:00) Evolution of the PNH treatment landscape (13:07) Selection and sequencing of therapies for patients with PNH (18:09) Overview and presentation of extravascular hemolysis (23:50) Case: A woman in her early 40s with PNH who developed Budd-Chiari syndrome and had an excellent response to C5 inhibition (26:57) Case: A woman in her early 40s with a suboptimal response to ecluizumab followed by an excellent response to pegcetacoplan on the PEGASUS trial (34:00) Case: A woman in her mid 40s who experienced breakthrough hemolysis with pegcetacoplan and was recently switched to iptacopan (38:40) CME information and select publications
Featuring perspectives from Dr Carlos M de Castro, including the following topics: Overview of paroxysmal nocturnal hemoglobinuria (PNH) (0:00) Complement C5 inhibition for patients with PNH (6:48) Proximal complement inhibitors for PNH management (17:17) CME information and select publications
Featuring a discussion on the biology and treatment of paroxysmal nocturnal hemoglobinuria with Dr Carlos de Castro, moderated by Dr Neil Love.
Dr Carlos de Castro from Duke Cancer Institute in Durham, North Carolina discusses the presentation, diagnosis and management of paroxysmal nocturnal hemoglobinuria. CME information and select publications here (https://www.researchtopractice.com/OncologyTodayPNH23)
Morag Griffin, Haematology Consultant, Leeds University Teaching Hospitals, UK, joins Jonathan to discuss rare haematological conditions, such as aplastic anaemia and paroxysmal nocturnal haemoglobinuria, as well as their treatments. They also discuss how vaccination response is affected by these diseases. Use the following timestamps to navigate the topics discussed in this episode: (00:00)-Introduction (01:13)-What led Griffin into haematology (02.00)-How Griffin's Master's degree in leadership helped her throughout her career (03.10)-Paroxysmal nocturnal haemoglobinuria (PNH) (09.13)-Griffin's research on biomarkers and laboratory assessments for monitoring the treatment of patients with PNH (12:44)-Aplastic anaemia (16:43)-Importance of international collaboration (19:34)-How aplastic anaemia and PNH affect vaccination responses (23:45)-Histiocytic disease (26:23)-Future research in haematology (29:02)-Three wishes for the future of healthcare
My interview with the band discussing the new album and much more! --- Support this podcast: https://podcasters.spotify.com/pod/show/robert-carrigan/support
Happy to be back. Did you get some good sleep? We hope so, because you'll need it for Episode 164. Tim from Paroxysmal returns to the show to talk extreme metal, his band, the new upcoming album, "Force Feeder" ( to be released June 30th, 2023 ), and the recent UAP whistleblower's ( not so ) shocking revelations. We also go topical and talk a little bit about the recent Titan disaster. Is it really a tragedy when you are just stupid? We're sorry to be so blunt, but... STUPID! Thanks for listening, scatterbrains! YOU are the backbone of this podcast! The death of Dennis Mallen right after our interview with him earlier this month really messed with Ian's head in particular, so we implore you ALL to be safe out there! Find us on all major platforms that support podcasts, as well as Instagram, Twitter ( ugh ), and Facebook. (c)2023 Scatterbrain Productions. Always. --- Send in a voice message: https://podcasters.spotify.com/pod/show/scatterbrain-podcast/message
Commentary by Dr. Valentin Fuster
In this week's episode, we'll learn how rare germline genetic variants in complement factor H (CFH) affect the course of paroxysmal nocturnal hemoglobinuria, discuss the role of coagulation factor XII in thrombotic complications and vaso-occlusion associated with sickle cell disease, and learn more about the overlapping features of therapy-related and de novo NPM1-mutated AML.
We sit down with Josh and Tim of San Diego brutal death metal act Paroxysmal (formerly Paroxysmal Butchering) to discuss their journey as a band, their new name and sound and their upcoming album. We talk all things brutal death metal, the San Diego music scene and the evolution of modern grindcore bands. We share our worst experiences working in customer service, go down a street taco and margarita rabbit hole, and we go way off topic discussing Jean-Claude Van Damme, the making of The Nightmare Before Christmas and Danny Elfman's transition from Oingo Boingo frontman to Hollywood film score legend. Listen to Paroxysmal: http://paroxysmalbutchering.bandcamp.com/ Follow Paroxysmal: Facebook: https://www.facebook.com/paroxysmalmetal Instagram: https://www.instagram.com/_paroxysmal_/
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: February 1, 2018 Mike Rubenstein, from prior episodes on global health and CSF interpretation, returns to discuss the case of a patient with recurrent headaches. But this time he uses big words. Take a listen. Produced by James E Siegler. Music by Mystery Mammal, Lee Rosevere, Unheard Music Concepts, and Greg Atkinson. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision-making. REFERENCES Bigal ME, Lipton RB. The differential diagnosis of chronic daily headaches: an algorithm-based approach. J Headache Pain 2007;8(5):263-72. PMID 17955166 Dodick DW. Clinical practice. Chronic daily headache. N Engl J Med 2006;354(2):158-65. Erratum in: N Engl J Med 2006;354(8):884. PMID 16407511 Goadsby PJ. Trigeminal autonomic cephalalgias. Continuum (Minneap Minn) 2012;18(4):883-95. PMID 22868548 Halker RB, Hastriter EV, Dodick DW. Chronic daily headache: an evidence-based and systematic approach to a challenging problem. Neurology 2011;76(7 Suppl 2):S37-43. PMID 21321350 Pareja JA, Antonaci F, Vincent M. The hemicrania continua diagnosis. Cephalalgia 2001;21(10):940-6. PMID 11843864 Prakash S, Patell R. Paroxysmal hemicrania: an update. Curr Pain Headache Rep 2014;18(4):407. PMID 24523000 Silberstein SD, Lipton RB. Chronic daily headache. Curr Opin Neurol 2000;13(3):277-83. PMID 10871251 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.
$5 Q-BANK: https://www.patreon.com/highyieldfamilymedicine Intro 0:30, Sickle cell anemia 1:34, Thalassemia 9:03, Hereditary spherocytosis 15:36, G6PD deficiency 17:38, Pyruvate kinase deficiency 19:27, Microangiopathic hemolytic anemia 20:08, Autoimmune hemolytic anemia 24:56, Paroxysmal nocturnal hemoglobinuria 26:59, Blood transfusion reactions 28:31, Drug-induced hemolysis 30:05, Malaria 30:42, Babesiosis 31:47, Iron deficiency anemia 32:34, Megaloblastic anemia 35:34, Lead poisoning 37:59, Porphyria 39:07, Sideroblastic anemia 40:01, Aplastic anemia 41:23, Polycythemia 45:24, Methemoglobinemia 46:34, Carbon monoxide poisoning 47:56, Hemophagocytic lymphohistiocytosis 48:48, Practice questions 49:34
In this episode, we review the high-yield topic of Benign Paroxysmal Positional Vertigo (BPPV) from the ENT section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
Welcome to Scatterbrain Podcast Episode 141, our 2022 Year End Review! Join us this week as we welcome back Tim and Josh from Paroxysmal Butchering. The guys update us on the latest PB news including the forthcoming album as well as the potential for live shows in 2023. We also talk with Tim about his new book "The Easter Outskirts: Non Stop Turbo Noir". Then we look back on the year's music releases. We revisit albums we reviewed as well as talk about some 2022 releases we didn't get around to talking about. Lots of great music came out in 2022; we barely scratched the surface. Finally, before we wrap up Season 3, Ian and I list our top albums of the year. Thank you again to all of our faithful listeners for your ongoing support. We appreciate anyone who's taken the time to listen and interact with us on the social medias. We look forward to another great year of Scatterbrain Podcast in 2023. Cheers! "Scatterbrain Podcast, with Ian and Dan: Subscribe, listen, and share!" --- Send in a voice message: https://anchor.fm/scatterbrain-podcast/message
The inaugural Deep Dive episode related to PNH and Ryan's story since being diagnosed in 2011. You'll learn a bit about the rare disease, his treatments and how his life has changed. The guys also discuss "Big Pharma", the healthcare system and other related topics.DONATE: Paroxysmal Nocturnal Hemoglobinuria (PNH) | Aplastic Anemia & MDS International Foundation (aamds.org)About PNH | Paroxysmal Nocturnal Hemoglobinuria (pnhsource.com)Paroxysmal Nocturnal Hemoglobinuria (PNH): Symptoms & Treatment (clevelandclinic.org)Rate the show 5 stars and share with your friends! Like right now! Subscribe to get automatic alerts and if you want to say something to the guys email them at connect@rtrtpodcast.com
Body farms, ghosts, and scuba diving! This week we're watching The Body Farm, and if you don't know what a body farm is, don't worry, it's exactly what it sounds like. Episode Information: The Body Farm S1 Ep3. Follow us on Instagram: @insidethemorguepod or Twitter: @insidethemorgue If you enjoy this podcast, support us! Music used from Pixabay.com: Crime Trap by Muzaproduction & Detective by SergeQuadrado Sources Used: https://en.wikipedia.org/wiki/Death_of_Tina_Watson https://www.theguardian.com/world/2009/jun/05/man-guilty-manslaughter-wife-scuba-death https://en.wikipedia.org/wiki/Paroxysmal_supraventricular_tachycardia https://entomologytoday.org/2017/10/03/the-flies-and-beetles-that-turn-death-into-dinner/ https://www.britannica.com/science/trachea https://medlineplus.gov/lab-tests/carbon-dioxide-co2-in-blood/ https://en.wikipedia.org/wiki/Decompression_sickness https://www.policemag.com/339804/how-to-photograph-injuries https://hastingsmuseum.org/wp-content/uploads/2020/05/Fingerprint-Info-Activities.pdf --- Support this podcast: https://anchor.fm/insidethemorgue/support
In this episode of the podcast, Dr Andrew Perry is joined by Professor Michiel Rienstra of the University Medical Center Groningen in the Netherlands. They discuss his paper “Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation” recently published in Heart. It is an interesting piece in the investigation to understand the pathobiology of atrial fibrillation. If you enjoy the show, please subscribe. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 Link to published paper: https://heart.bmj.com/content/early/2022/07/20/heartjnl-2022-321027
In this episode, we review the high-yield topic of Paroxysmal Nocturnal Hemoglobinuria (PNH) from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
Welcome to Scatterbrain Podcast Episode 121: Our UFOs with Paroxysmal Butchering. First off, Ian and Dan get into a back and forth about time travel. Can a human travel to the future, the past, or both? And, what are some classic movies that absolutely could not be made today? Then, Tim and Josh return to the show to talk with the guys about their own UFO/UAP sightings. People who live in Southern California have a higher percentage chance of seeing anomalous craft, lights, and "things" in the sky ( and even shooting into and out of the ocean ) than most people on Earth not living in Brazil, Russia, UK, or Hudson Valley. It's not just Ian, but Josh and Tim have had their own sightings, and recount their experiences for us. We also jibber-jab about the U.S. Secret Space Force, the petroleum industry, fossil fuels, and renewable energy. Then to close out, Tim gives out some super cool information about upcoming P.B. shows, their soon-to-be-released new album, and his new book "The Eastern Outskirts". It's AVAILABLE NOW! Buy it! And read it! It's really fucking good! Live, listen, learn, and laugh like you're dying tomorrow! Because what's the point if you don't enjoy the ride? Thanks for listening, Scatterbrains! Knowing you're out there makes this all worthwhile! Find us on all major platforms that support your favorite podcasts, as well as Twitter, Facebook, and Instagram. (c) 2022 Scatterbrain Productions. Always. --- Send in a voice message: https://anchor.fm/scatterbrain-podcast/message
Welcome to Scatterbrain Podcast Episode 120, with special guests Josh and Tim from San Diego-based brutal death metal band, Paroxysmal Butchering. After Dan and Ian get into a full-blown discussion about kegerators and brewing beer, the guys welcome Tim ( vocals ), and Josh ( guitars ) to the show. After a brief history of their band, Paroxysmal Butchering, Tim recounts his experiences living in a very large, very haunted apartment complex some years back. Strange and sometimes violent paranormal events that have all the hallmarks of poltergeist activity. Listen to his tale, and judge for yourself. Josh, Ian, and Dan also have a ghost story of their own to tell for good measure. Enjoy episode 120 with Josh and Tim, because we had a blast recording with these guys! In fact, you'll be hearing more from them on episode 121, and hopefully they will guest-host the show on other upcoming episodes as well. Thanks for listening, everyone! Catch us on all major platforms that support podcasts, as well as Twitter, Instagram, and Facebook. If you have topic ideas, or just want to tell us how we're doing, we would love hearing from you. Thank you for all the kind comments from our listeners, as well as the many musicians in bands we've covered over the last 29 months. When we say, "YOU ROCK!", we mean it! (c) 2022 Scatterbrain Productions Always. --- Send in a voice message: https://anchor.fm/scatterbrain-podcast/message
Ep. 82 - Paroxysmal Butchering by Cali Death Podcast
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