Podcasts about valvular heart disease

Focus Issue on Genetics and Valvular Heart Disease

KYW Newsradio's Rasa Kaye and Deborah Heart and Lung Center's Interventional Cardiologist, Dr. Muhammad Raza discuss diagnosing and treating valvular heart disease and the exciting future in the heart valve research space.

Focus Issue on Valvular Heart Disease

Focus Issue on Valvular Heart Disease, Heart Failure and Cardiomyopathies

Focus Issue on Heart Failure and Valvular Heart Disease

With Kwan-Leung CHAN & Lawrence Lau, University of Ottawa Heart institute - Canada. Link to editorial Link to paper

Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research that was presented at the 2024 European Society of Cardiology annual meeting. Visit NEJM.org to read the latest research.

Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research that was presented at the 2024 European Society of Cardiology annual meeting. Visit NEJM.org to read the latest research.

Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research that was presented at the 2024 European Society of Cardiology annual meeting. Visit NEJM.org to read the latest research.

Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research that was presented at the 2024 European Society of Cardiology annual meeting. Visit NEJM.org to read the latest research.

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

Focus Issue on Heart Failure, Valvular Heart Disease, and Arrhythmias

Focus Issue on Valvular Heart Disease, Diabetes, Metabolic Disorders, and Hypertension

In this episode, Tim Madeira, cardiothoracic DNP,  provides an overview of the primary heart valve diseases. He expertly guides us through the complex physiological processes underlying conditions like stenosis and valve regurgitation arising from congenital abnormalities, calcifications, infective endocarditis, and trauma. In addition, Tim outlines the latest evidence-based standards in surgical, percutaneous and medical interventions that nurses find themselves managing in the hospital.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse:Get 15% off of her resume and cover letter templates using the promo code UPMYGAMENursing students and new grad career services Experienced RN career servicesNP career servicesSee the show notes at upmynursinggame.com.

Host: Darryl S. Chutka, M.D. [@chutkaMD] Guest: Rekha Mankad, M.D. Mitral valve disorders are extremely common, one of the most common is mitral valve prolapse. The majority of these patients live their life without symptoms, but some go on to develop significant mitral regurgitation or less likely, mitral stenosis. How can we recognize mitral valve disease and what's recommended to confirm a diagnosis? How should these patients be followed? Do they need a lifetime of cardiac imaging? When is a cardiologist needed to help manage these patients? In this podcast, we'll discuss these questions and more with cardiologist Rekha Mankad, M.D., a cardiologist from the Mayo Clinic. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Host: Darryl S. Chutka, M.D. [@chutkaMD] Guest: Rekha Mankad, M.D. It's estimated that between 2% and 3% of the population has some form of valvular heart disease and this increases with age. Most of these patients are initially cared for by primary care providers. Most valvular disease deaths are due to disease of the aortic valve and it's important to recognize these patients early in order to assess for progression and the need for surgical intervention. What are the presenting symptoms of aortic valve disease? What's the best way to manage and follow these patients and when should a cardiologist and cardiac surgeon become involved in the care of the patient? In this podcast, we'll discuss these questions and more with cardiologist Rekha Mankad, M.D., from the Mayo Clinic. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Commentary by Dr. Valentin Fuster

Focus Issue on Valvular Heart Disease

Dr. Pierre Elias sits down with Catherine Price to talk about how utilizing technologies like artificial intelligence and machine learning can help diagnose patients even before symptoms develop, and support doctors by freeing them up to focus on providing personalized care to their patients. They discuss navigating bias in both artificial intelligence and clinical care, and how new technology will improve the future of medicine. For more information visit nyp.org/Advances

This episode covers valvular heart disease and murmurs.Written notes can be found at https://zerotofinals.com/medicine/cardiology/valvularheartdisease/ or in the cardiology section of the 2nd edition of the Zero to Finals medicine book.The audio in the episode was expertly edited by Harry Watchman.

With Daniela Tomasoni and Marianna Adamo, University of Brescia, Brescia - Italy. In November's HFA Cardio Talk, Dr. Daniela Tomasoni interviews Dr.Marianna Adamo on valvular heart disease in heart failure. The podcast starts with an epidemiological overview and then addresses the main pathophysiological mechanisms of valvular heart disease in patients with heart failure. It also discusses current recommendations regarding the treatment of mitral regurgitation. In conclusion, dr. Adamo will guide us through the new available percutaneous devices for the treatment of tricuspid regurgitation.

Commentary by Dr. Valentin Fuster

Focus Issue on Valvular Heart Disease

Why Quantitative Measures Matter in Valvular Heart Disease Guest: Jeremy J. Thaden, M.D. (@JeremyThaden) Host: Kyle W. Klarich, M.D. (@KyleWKlarich) Joining us today to discuss Why Quantitative Measures Matter in Valvular Heart Disease is Jeremy Thaden, M.D., assistant professor of cardiovascular medicine and vice chair for the division of cardiac ultrasound at Mayo Clinic in Rochester, Minnesota. Specific topics discussed: How do you use valve quantification in echo and what are specific examples of quantitation in valvular heart disease? What is the benefit of quantifying valvular lesions? Where do you see echo quantitation going in the future? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW 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.    

DCS 1401: Valvular heart disease

Commentary by Drs. Jonathan Windram, Claudio Montalto, and Uri Elkayam

Commentary by Grant W. Reed

Commentary by Dr. Valentin Fuster

Do you have a reliable roadmap for optimizing care during a crisis? On MedAxiom HeartTalk, host Melanie Lawson speaks with guests Elizabeth Perpetua, DNP, ACNP-BC, FACC, Kimberly Guibone, DNP, ACNP-BC, FACC, Martina Kelly Speight, MSN, FNP-BC, and Joan Michaels, RN, MSN, CPHQ. They share insights from their PEARLS paper – a blueprint for structural heart programs to optimize care and improve outcomes while facing profound obstacles.Guest Bios:Elizabeth Perpetua, DNP, ACNP-BC, FACC: Founder of Empath Health Services and faculty at University of Washington in Seattle – Dr. Perpetua led the efforts and development of the PEARLS paper and the first published study describing the Structural Heart Coordinator role and Coordination in the U.S. She is a Doctor of Nursing Practice with 15 years of experience in structural heart program development and research. She was the Director of the structural heart programs at Swedish Medical Center and University of Washington before starting her work in consulting and education. Dr. Perpetua has trained thousands of nurses, physicians, and administrators in structural heart disease.Kimberly Guibone, DNP, ACNP-BC, FACC: Structural Heart Clinical Program Manager at Beth Israel Deaconess Medical Center in Boston. Dr. Guibone brings extensive experience as a Doctor of Nursing Practice and the first valve coordinator of her structural heart program. She has contributed to multiple research papers helping to define the role of the valve center coordinator.Martina Kelly Speight, MSN, FNP-BC: Board-certified Nurse Practitioner in the Structural Heart Program at Stanford Health Care in California. Martina established her role on the Stanford multidisciplinary heart team in 2008 where she coordinated research efforts and greatly contributed to program development. In her role as Nurse Practitioner, Martina Speight has become a clinical expert in the care and management of patients undergoing treatment for Valvular Heart Disease. She is passionate about leading efforts that improve program outcomes, efficiencies, and patient experiences. Martina has contributed to multiple publications and speaks nationally about Heart Valve Disease and Structural Heart Program development.Joan Michaels, RN, MSN, CPHQ: Director of Cardiac Registries for the American College of Cardiology in D.C. Joan brings more than 30 years of experience in cardiology as a registered nurse and expertise overseeing the STS/ACC TVT Registry.

In this episode we discuss cardiogenic shock due to valvular heart disease. Join Dr. Pranoti Hiremath (Interventional cardiology fellow, Johns Hopkins), Dr. Karan Desai (CN Critical Care Series Co-Chair, Cardiology fellow, University of Maryland), Dr. Yoav Karpenshif (CN Critical Care Series Co-Chair, Chief cardiology fellow, University of Pennsylvania), and Amit Goyal (CardioNerds Co-Founder) as they interview Dr. Paul Cremer (Associate Director of the Cardiac Intensive Care Unit and Associate Director of the Cardiovascular Fellowship at the Cleveland Clinic) in this broad overview of valvular shock. We discuss the nuances in diagnosis, differing presentations and how physical exam, multi-modality imaging, and invasive hemodynamics can inform management. Audio editing by Dr. Gurleen Kaur (Director of the CardioNerds Internship and CardioNerds Academy Fellow). The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Cardiogenic Shock and Valvular Heart Disease Shock due to valve disease is the result of a structural abnormality that may be temporized with medical therapy and circulatory support devices. However, it is ultimately best treated with a structural solution in the form of either percutaneous valvular therapies or cardiac surgery.When treating a patient with cardiogenic shock with normal or hyperdynamic ventricular function, we should keep a high index of suspicion for valvular disease. The cardiac output may be reduced due to a stenotic lesion “blocking” forward flow or regurgitant lesion causing backward flow.Acute mitral and aortic regurgitation will typically not manifest as a loud murmur on physical exam. The combination of hypotension and rapid flow of regurgitant blood on an “unprepared” cardiac chamber results in rapid equalization of chamber pressures, shortening the intensity and duration of the murmur. On transthoracic echocardiogram, for instance with acute MR, color Doppler may not show a large turbulent jet, and thus the MR may be underestimated or not appreciated at all.Echocardiography is critical to understand the etiology and severity of valvular shock, and invasive hemodynamics are often needed to guide medical and mechanical interventions.In multi-valve disease with severe aortic stenosis and functional mitral regurgitation, we typically treat the aortic stenosis first, since the mitral regurgitation may improve from the reduction in afterload associated with treating aortic stenosis. Show notes - Cardiogenic Shock and Valvular Heart Disease 1. Shock due to valve disease arises due to a structural problem that may be temporized with medical therapy and circulatory support devices, but is ultimately best treated with a structural solution in the form of either percutaneous valvular therapies or cardiac surgery. Stabilizing therapies for acute mitral regurgitation include afterload reduction with vasodilators, diuresis as needed to reduce pulmonary edema, and mechanical circulatory support including intra-aortic balloon pumps.Therapies for acute aortic regurgitation are typically more limited and include vasopressors such as epinephrine.  Bradycardia should be avoided with agents such as dobutamine or temporary pacing to reduce time in diastole. Temporary mechanical circulatory support options are limited in the setting of acute AR, though case reports of techniques such as LAVA ECMO (left atrial venoarterial extracorpeal membr...

The Scope is dedicated to having open conversations about healthcare topics relevant to our patients and community. Whether you are trying to answer your own healthcare questions or want to be more informed when scheduling appointments for loved ones, this show is dedicated to helping you become more knowledgeable and involved. In this episode, Tim Martin, a cardiologist with the Phelps Health Medical Group, talks about valvular heart disease. Resources: • Timothy J. Martin, MD: https://phelpshealth.org/doctors/timothy-j-martin-md-facc • Phelps Health Cardiology: https://phelpshealth.org/conditions-treatments/cardiology You can connect with Phelps Health on the following platforms: • Website: https://phelpshealth.org • Facebook: https://facebook.com/PhelpsHealth1 • Instagram: https://www.instagram.com/phelpshealth1/ • LinkedIn: https://www.linkedin.com/company/14525428 • YouTube Channel: https://youtube.com/c/PhelpsHealth1 • Sound Cloud: https://soundcloud.com/user-550445603

Focus Issue on Valvular Heart Disease

The eighth panel of DCS 1400: Valvular Heart disease

The eighth panel of DCS 1400: Valvular Heart disease

Commentary by Dr. Valentin Fuster

CardioNerds (Amit Goyal and Daniel Ambinder), Cardio-OB series co-chair and University of Texas Southwestern Cardiology Fellow, Dr. Sonia Shah, and episode FIT lead and UT Southwestern Cardiology Fellow Dr. Laurie Femnou discuss valvular heart disease in pregnancy with cardio-obstetrics expert Dr. Uri Elkayam, Professor of Medicine and OB Gyn at the University of Southern California. In this pearl-packed episode, we discuss the diagnosis, acute management, and long-term considerations of valvular heart disease in pregnancy. Through a series of cases, we review the physiologic changes in pregnancy that make certain valvular lesions well-tolerated, while others are associated with a much higher risk of peripartum complications. We also discuss which patients to consider referring for valvular intervention, the ideal timing, and which valvular interventions are safest in the peripartum period. We promise, you won't want to miss this clinically high-yield episode with Dr. Elkayam, the father of cardio-obstetrics and an absolute legend in the field! Audio editing by CardioNerds Academy Intern, Adriana Mares. Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardio-Obstetrics Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Most women with severe valvular heart disease can be managed medically throughout pregnancy.Right sided valvular lesions are generally better tolerated than left-sides lesions, and regurgitant lesions are generally better tolerated than stenotic lesions. However, the context and etiology of the valve dysfunction must be taken into consideration. Severe tricuspid valve regurgitation, for example, can be associated with a failing right ventricle and undiagnosed pulmonary hypertension. Changes in BNP, severity of symptoms, and right ventricular systolic pressure (RVSP) assessed by echocardiography can be helpful in differentiating normal pregnancy-related symptoms from symptoms due to hemodynamically significant valvular lesions.Valvular interventions during pregnancy are safe when well-planned and performed by experienced operators, and they can significantly improve morbidity and mortality in women who remain symptomatic despite medical management.A multidisciplinary team-based approach is important when managing patients with valvular heart disease during pregnancy. Quatables “We do not need to perform prophylactic valvular intervention in women prior to pregnancy if they do not meet criteria for intervention otherwise. A patient with regurgitant lesion will tolerate pregnancy well, provided that they are not                candidates for surgery already.” “Valvuloplasty during pregnancy is a great and effective procedure, but restenosis occurs. For women who desire future pregnancies, preconception evaluation is important to determine if valve intervention is indicated prior to conceiving.” Show notes What is the epidemiology of valvular heart disease in pregnancy?Cardiovascular conditions affect up to 4% of pregnancies, with valvular heart disease being the most common cardiac pathology encountered during pregnancy worldwide.In the developing world, rheumatic valve disease is still the most common etiology, with mitral valve most commonly affected, followed by the aortic valve.In the developed world, congenital aortic valve pathology is most common. What are the hemodynamic effects of stenotic vs. regurgitant lesions during pregnancy?In normal pregnancy, there is a significant drop in systemic vascular resistance as early as 5 weeks gestational age. This drop leads to a transient decrease in perfusion to the kidneys, causing an increase in fluid retention and expansion of plasma volume. At the same time, there is an increase in heart rate which becomes more pronounced la...

Dr. Memon concludes the lecture on Arrythmias and begins the lecture on Valvular Heart Disease.

With Friedhelm Beyersdorf, University Heart Center Freiburg, Bad Krozingen - Germany & Alec Vahanian, University Paris-Descartes, Paris - France Link to paper

Commentary by Drs. Julia Grapsa and Rafael Vidal Pérez

Cardiac pathophysiology can be one of the hardest topics to master in medical school. We're lucky to have MS4 Anisha Reddy help out in this area by reviewing some of the basics of valvular heart disease. We'll present lots of vignettes, provide some pearls, and cover these diseases the way they are tested on boards.

Focus Issue on Valvular Heart Disease

#017  In this episode we will discuss commonly encountered cardiac valve disorders including:Mitral RegurgitationAortic StenosisMitral StenosisAortic RegurgitationRemember to head over to my website and subscribe while you are there to receive a Basic Rhythm Interpretation Cheat Sheet!  www.kayhoppepresents.com Join me on Facebook for the 'CCRN Question of the Day Challenge' @kayhoppepresentsStay tuned for the Online CCRN Review Course coming in September 2021I hope to see you in future episodes!Have a blessed day!Kaykay@kayhoppepresents.com

Transcatheter valve repair has emerged as an important therapeutic option for patients with aortic and mitral valve disease. JAMA Deputy Editor Gregory Curfman, MD, interviews Charles Davidson, MD, clinical chief of Cardiology at Northwestern University, to review the range of indications and procedures now available, including transcatheter aortic valve implantation (TAVI), valve-in-valve procedures after bioprosthetic valve failure, and mitral valve transcatheter edge-to-edge repair. Related Article: Transcatheter Treatment of Valvular Heart Disease

In this episode, two game-changer trials about transcatheter edge to edge repair will be reviewed, we hope you enjoy this epsidoeyou can also download the slides via this link:http://ecardiocast.com/wp-content/uploads/2021/05/Secondary-MR-TEER.pdf

In this episode, you will find the latest pathophysiology, etiologies, classification, and management of secondary mitral regurgitation, enjoy the next 20 minutes being with usyou can also download the slides via this link:http://ecardiocast.com/wp-content/uploads/2021/05/secondary-MR-1.pdf

Commentary by Dr. Valentin Fuster

Today we are joined by heavy hitter Dr. Brian Locke to talk about the new paper on 3 vs 8 days of antibiotics for pneumonia, a clever new paper looking at whether there is any association between IV contrast and kidney function, and a new retrospective study on DOAC use for valvular atrial fibrillation.  Check it out! Three Days of Antibiotics for PneumoniaIV Contrast and Kidney FunctionDOACs for Valvular Atrial FibrillationMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

In this episode, the Good GP interviews two cardiac specialists on valvular heart disease, focussing on aortic and mitral valve disease. We explore aortic stenosis and the Transcatheter Aortic Valve Implantation (TAVI) procedure, mitral valve disease and related procedures. Dr Michael Muhlmann is a Consultant Cardiologist and Interventional Cardiologist at Hollywood Private Hospital, Sir Charles Gairdner Hospital, and Joondalup Health Campus Associate Professor Jurgen Passage is Cardiothoracic Surgeon and Head of the Department of Cardiothoracic Surgery at St John of God Hospital Subiaco.

This week feature a Double Feature of Discussions. In our first discussion, author Larry Allen and Associate Editor Justin Grodin discuss the article "An Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction: The EPIC-HF Trial." Then in our second discussion, author Benjamin Scirica and Associate Editor Sandeep Das discuss the Research Letter "Digital Care Transformation: Interim Report From the First 5000 Patients Enrolled in a Remote Algorithm-Based Cardiovascular Risk Management Program to Improve Lipid and Hypertension Control." TRANSCRIPT BELOW Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Dr. Greg, I really love these double features that we have in 2021. Let me tell you about the first one. We are going to be talking about the EPIC heart failure trial. That's the electronically delivered patient activation tool for intensification on medications in HFrEF. Very important results. Dr. Greg Hundley: Yes, Carolyn. And the second feature is going to evaluate an algorithm based cardiovascular risk management program to improve lipid and hypertension control. But before we get to the double feature, how about we grab a cup of coffee and start with some of the other articles in the issue? Dr. Carolyn Lam: My coffee is right here and I want to talk about, guess what? SGLT2 inhibitors again for this first paper. Dapagliflozin, as we know, reduces the risk of end stage renal disease in patients with chronic kidney disease. We saw that in the DAPA-CKD trial. However, the primary and secondary preventive effects of SGLT2 inhibitors on cardiovascular outcomes have not been studied in patients with chronic kidney disease, with and without diabetes. Dr. Greg Hundley: Well Carolyn, remind us a little bit, what were the end points in the DAPA-CKD trial? Dr. Carolyn Lam: Okay, well yes. DAPA-CKD as a reminder, randomized more than 4,000 participants with chronic kidney disease to dapagliflozin, 10 milligrams daily or placebo. The primary endpoint was a composite of sustained decline in GFR of more or equal to 50% or end stage kidney disease or kidney or cardiovascular death. The secondary end points were a kidney composite outcome, the composite of hospitalization for heart failure or cardiovascular death and all cause death. Now the current paper is a pre-specified subgroup analysis where authors led by Dr. John McMurray from University of Glasgow, divided patients into primary and secondary prevention subgroups according to the history of cardiovascular disease. And results showed that dapagliflozin reduced the risk of the primary composite outcome to a similar extent in the primary and secondary prevention groups. This was also true for the composite of heart failure hospitalization or cardiovascular death and all cause mortality. The combined cardio renal benefits of SGLT2 inhibitors in patients with chronic kidney disease with and without diabetes therefore are substantial, whether there is history of cardiovascular disease or not. Dr. Greg Hundley: Not very nice, Carolyn. Well, my paper comes from Dr. Pradeep Natarajan and his colleagues at the Massachusetts General Hospital. And Carolyn, this study evaluated whether premature menopause is associated with CHIP. For our listeners, CHIP stands for clonal hematopoiesis of indeterminate potential and it is the age related expansion of hematopoietic cells with leukemogenic mutations without detectable malignancy. And previously it's been shown associated with accelerated atherosclerosis. Dr. Carolyn Lam: Yikes. Greg, is pretty much our menopause associated with CHIP? Dr. Greg Hundley: Well Carolyn, the investigators, among 19,606 women, they identified 418 or 2.1% with natural premature menopause and 887 or four and a half percent with surgical premature menopause. Premature menopause, especially the natural premature menopause was independently associated with CHIP among post-menopausal women. Natural premature menopause, therefore may serve as a risk signal for predilection to develop CHIP and CHIP associated cardiovascular disease. Dr. Carolyn Lam: Interesting. Okay. Well, my next paper really provides the first evidence for endogenous induction of type-1 protein kinase A disulfide formation in the heart and this occurring after ischemia and re-profusion in both humans and mice. Dr. Greg Hundley: Ah Carolyn, so tell us more about this interesting paper. Dr. Carolyn Lam: Well, this is from Dr. Simon from University of Oxford and colleagues who used high spatial and temporal resolution imaging modalities in conjunction with an interesting redox dead type-1 protein kinase A knock-in mouse model and demonstrated that disulfide modification targets this type-1 protein kinase A to the lysosome where it acts as a gatekeeper for two poor channel mediated calcium release and prevents inappropriate triggering of calcium release from the sarcoplasmic reticulum. In the post ischemic heart, they found that inhibition of lysosomal calcium release by these oxidized molecules was crucial for limiting infarct size and preserving cardiac function during re-profusion. All this thus offering a novel target for the design of cardio-protective therapeutics. This is discussed in an editorial by Doctors Westenbrink, Nijholt, and deBoer from University Medical Center Groningen. Dr. Greg Hundley: Thanks, Carolyn. Very nice. Well, my last paper comes from Dr. Nicholas Marston and colleagues from the TIMI study group at Brigham and Women's Hospital of the Harvard Medical School. Carolyn, genome wide association studies have identified single nucleotide polymorphisms or SNIPs that are associated with an increased risk of stroke. The authors sought to determine whether a genetic risk score could identify subjects at higher risk for ischemic stroke after accounting for traditional clinical risk factors across five trials involving the spectrum of cardiometabolic disease. Dr. Carolyn Lam: Interesting. And these genetic risk scores are very hot. What did they find? Dr. Greg Hundley: Thanks, Carolyn. Among 51,288 subjects across the five trials, a total of 960 subjects had an ischemic stroke over a median follow-up of two and a half years. Across a broad spectrum of subjects with cardiometabolic disease, a 32 SNIP genetic risk score was a strong, independent predictor of ischemic stroke. In patients with atrial fibrillation, but lower CHA2DS2-VASc two scores, the genetic risk score identified patients with risk comparable to those with higher CHA2DS2-VASc two scores. Dr. Carolyn Lam: Wow, that really is impressive. Well, guess what? We've got some other articles in today's issue. There's a beautiful White Paper about the definitions and clinical trial design principles for coronary artery chronic total occlusion therapies and this from the CTOARC consensus recommendations by Dr. Rinfret and colleagues from McGill University. There's a Research Letter entitled, The Randomized Control Trial to Evaluate the Effect of Dapagliflozin on Left Ventricular Diastolic Function in Patients with Type II Diabetes. And this is from Dr. Hong and colleagues from Yonsei University College of Medicine in Korea. Dr. Greg Hundley: Thanks, Carolyn. Well I have an exchange of letters from Doctors Albiero and Xie regarding the previously published paper, Patent Foramen Ovale Could be a Source of Paradoxical Embolism and Lead to Adverse Outcomes in Hospitalized Patients with COVID-19 Pneumonia and DVTs.” There's also a Perspective piece to the 2020 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease from Dr. Bavry. And finally Carolyn, Dr. Tung has an ECG Challenge entitled, “Narrowing the Differential Diagnosis for a Wide Complex Tachycardia.” Well, how about we get on to both of our double features. Dr. Carolyn Lam: Let's go, Greg. Dr. Greg Hundley: Well listeners, we are here for our first feature discussion and we have with us today, Dr. Larry Allen from University of Colorado and our own associate editor, Dr. Justin Grodin from University of Texas Southwestern Medical School in Dallas, Texas. Welcome gentlemen. Larry, could you walk us through the background that really formulated your hypothesis? And then what was the hypothesis that you wanted to test with your study? Dr. Larry Allen: Well, thanks again for having me. I'm a heart failure doctor. The research group that I work with has spent a lot of time on patient empowerment and think about medication prescribing for HFrEF as shared decision making. Thinking about this as a discussion between the patient and me, rather than me deciding what to do. As you know, patients are now coming into the office because they've seen direct to consumer advertising around medications, but typically those are very biased. They're advertisements that are for only patented drugs. And what I'm really trying to think about is what is my patient's overall regimen in terms of heart failure? Dr. Larry Allen: And so we developed a tool which was a three minute video to tell patients that they should come into their visit and be excited to have discussions about their medicines and then a one page checklist that basically said, "Here's what an optimal regimen of medicines looks like for a patient with heart failure and reduced ejection fraction and nobody's really on a perfect regimen, but these are all the possibilities that you could have." Our hypothesis was that if we delivered that to patients before the clinic visit, that it would lead to better prescribing of these drugs. Essentially we imparted on a randomized trial within our healthcare system to do that and that's what we're discussing today, the results of the EPIC heart failure trial. Dr. Greg Hundley: Very nice, Larry. Tell us a little bit, what patients did you enroll in your trial? And then what outcomes did you work to assess? Dr. Larry Allen: We're part of the UC Health System, which has 12 hospitals, but a number of cardiology clinics across the front range of Colorado. Our entire system is on a single instance of the EPIC electronic health record so we're now able to essentially automatically identify all the patients in our system who have HFrEF. We generated lists of patients who had HFrEF who were going to see a cardiology provider in clinic and then we identified them ahead of time, enrolled them in the study prospectively. And the enrollment was for them to agree to be randomized in the study and then for us to be able to collect data on them. Dr. Larry Allen: The patients were kind of a wide range of HFrEF. They were an average of 65 years old, about 70% of the patients were male and reflected the race and ethnicity of Colorado with 11% Blacks and about 7% Hispanics. And everybody in the study had an ejection fraction of 40% or less on their last echocardiogram or other recent cardiac study. And then they were randomized to either get this three minute video sent to them as an email or as a text link that kicked them over to the one page checklist. And then we had them come in. A 145 patients came to clinic having got the information and a 145 patients just came to clinic like usual. Dr. Greg Hundley: Very nice. What did you find, Larry? What were your results? Dr. Larry Allen: Yeah, so we found not surprisingly that the majority of patients who were in usual care had no change to their medical regimen. What we found in the patients who received the EPIC heart failure three minute video and checklist, we saw about a 19% absolute increase in intensification of guideline directed medical therapy. And then we found that most of that was actually an increase in beta blocker dose prescribing. To some extent, the cheapest therapy that could be increased on a drug that people are already on. Dr. Greg Hundley: Very good. Well Justin, we'll turn to you. Help us put the results from Larry's work in the context of A, management of patients with heart failure and reduced ejection fraction and then also B, tell us a little bit about what attracted you to this article and maybe even where you see some of this going next. Dr. Justin Grodin: Thanks, Greg. And Larry, obviously I want to echo Greg's comments by thanking you for your submission. This was a paper that we thought obviously very highly of. Greg, for your first point, we've got novel therapies, but really one of the major issues now is not can we find a newer, better drug? I think we've all come to this realization, it's scalability and implementing these therapies into our regular practice, like beta blockers, RAS inhibitors and mineralocorticoid receptor antagonists. And as Larry said, the problem now is not the quality of our therapies, it's really scaling it and getting it to everyone. It's also increasing these therapies to optimum dosages in patients that can tolerate it over time. Dr. Justin Grodin: And then, to answer your second question, I think some of the things that struck us by this was that this is a wonderfully simple intervention that truly does empower patients. The majority of our interventions to optimize medical therapy has been targeting the physicians, the APP, the nurses, et cetera. This is beautiful in that it empowers the patient and we are putting the ball in their court. And I think to kind of dovetail with your third question, this is a health system clinical trial and I think that tells us a few things. I think one, it provides the framework on how one could perhaps implement that in their health systems. And we'll have to see if this is something that could translate to other health systems across the country or multiple centers. But I think really the intrigue with this work is that it all comes back to empowering the patients. Dr. Greg Hundley: Very nice. Dr. Larry Allen: Greg, I wanted to just add one thing that in the heart failure community, there's this argument going back and forth about whether the lack of optimization of guideline directed medical therapies is due to intolerance or whether it's due to therapeutic inertia. And one of the things I like about this study is on face value, we're empowering patients, but the fact that by asking patients to get involved in prescribing decisions, I think one of the take home messages is that this is partially about therapeutic inertia and that as clinicians, we have a lot of things we're dealing with. And if patients come in to the clinic visit and they're motivated to make these changes actually, we can intensify the therapy. Dr. Greg Hundley: Very good. Larry and Justin, both one at a time here quickly, in the last minute that we have, what do you see as the next study, Larry, that needs to be performed in this space? Dr. Larry Allen: I see two things quickly. One is, as Justin mentioned, validating that this kind of intervention, while simple can be pragmatically deployed in other health systems and in other contexts. The second thing is how do we integrate this kind of small intervention with the larger overall care of patients? One of the concepts that I've talked a lot about over the years with others, including Len Stevenson, is this concept of an annual heart failure review, where rather than seeing people on multiple short visits where we tackle small issues, we actually create a little bit of time to stand back and take a global view of heart failure therapy and how that heart failure therapy fits into the goals of care for the patient, the other medical problems they have and where they're headed. Dr. Greg Hundley: Very good. Justin, anything? Dr. Justin Grodin: Greg, I have to agree with Larry. I think he hit the nail on the head with his first comment. At least for me from an editorial standpoint is really we like to see how generalizable this is and really this implemented in other health systems. I think that's the logical next step. I can tell you, at least from our discussions at our medical center about this manuscript since it's been published at Circulation is, is there something like this we could implement in our own health system? Or in the health systems that we're affiliated with? Dr. Larry Allen: And I would just add that this research and the intervention was funded by the American Heart Association under the strategically focused research network for heart failure and so we've made the interventions public they're online at the research website we have, patientdecisionaid.org. Dr. Greg Hundley: Well fantastic. Well listeners, we want to thank Dr. Larry Allen from University of Colorado and our associate editor, Dr. Justin Grodin from UT Southwestern, for bringing us this article, demonstrating a process that facilitates patient physician interactions to improve the administration of guideline based therapy to patients with heart failure and reduced ejection fraction. And so we're going to wind up this feature discussion and we will head to our next feature. Dr. Greg Hundley: And we have with us Dr. Benjamin Scirica from Brigham and Women's Hospital and our own associate editor, Dr. Sandeep Das from UT Southwestern. Benjamin, could you tell us a little bit about the background information that you used to formulate your hypothesis that you wanted to test for this study? Dr. Benjamin Scirica: Thanks so much first for the invitation. It's a great honor to obviously be in Circulation and to be part of this podcast. We started with the recognition that in our practice, which is similar, I think to a lot of the United States, we are not doing as good a job as we could in terms of care for a lot of the chronic cardiovascular conditions we see. And hypertension and high cholesterol are one of those clear areas where we know there are very good guidelines with clear indication for therapy in specific situations and that these drugs that are available are predominantly generic. But when we looked at our registries, we found that we were not doing as well as we thought. We felt that there are a lot of reasons for that. Dr. Benjamin Scirica: A lot of it was based on the fact that for something good to happen, the right thing to happen, you have to have a patient and a doctor in the same room, the doctor has to recognize that there's a problem. They have to know that there is something they can do about it. They have to be able to convince the patient or educate the patient that they should start this new therapy. They have to know how to start the therapy and then have the ability to follow up and make sure that there is longitudinal care for these chronic diseases. Dr. Benjamin Scirica: And that's a lot to ask for any of us when we have 15 minutes to see the patient, we may only see the patient a couple times a year at most. And so we felt that our hypothesis is, could we design a program, would be delivered remotely, that would not require a doctor in the middle of all of these decisions and that we could scale by using lower cost resources, non-licensed healthcare coordinators or navigators and pharmacists who could follow very clear treatment algorithms to be able to identify patients and prescribe the right medicines to patients at the right time, based on their cardiovascular risk. Dr. Greg Hundley: What was your study design? And what was your study population? Dr. Benjamin Scirica: This is an active, ongoing quality improvement program where our hypothesis is that by doing this, we could improve patients' lipids and cholesterol prescriptions compared to prior. And we did some analysis and we saw that a lot of these patients had not been on optimal therapy for many years, even though they've been in our system. With the limitations of not having randomization, we identified these patients and through different clinics in the different hospitals, and would either have patients referred to us by providers or more commonly go and find them within the registries and identify the patients and contact them and have them enter our program where they would usually take somewhere between eight to 12 weeks to be actively managed, to get to their goals and then they'd enter a maintenance program. The report that we do now is that the story of the first 5,000 patients who we enrolled in our program of whom about 35% were still in management at the time we presented these ongoing results. Dr. Greg Hundley: Roughly how old were these participants? And what was the breakdown in terms of gender or sex distribution? Dr. Benjamin Scirica: We found that about 12% were over 75 years old, a little over half were female. We had 71% who are non-Hispanic Caucasian and 8% who were non-English speaking. In terms of their cardiovascular risks, about a third of the patients had established cardiovascular disease, about a quarter of the patients had diabetes and about a third had an LDL of more than 190 milligrams per deciliter, but no history of ASCVD or diabetes. And then for hypertension, we really would take anybody whom the physician felt required further blood pressure management, because their blood pressure was over 130 over 85. Dr. Greg Hundley: And what did you find? Dr. Benjamin Scirica: We found that of the 5,000 patients that we enrolled, about 4,000 were in the lipid program, a little over 1,400 we're in the hypertension program, so some patients were in both programs and in the lipid patients, in those patients who achieved maintenance, we increased lipid therapy, any lipid lowering therapy, from about 78% up to 97%. And that was predominantly through statins but we doubled the use of ezetimibe from 9% to 17%. We saw a small increase in PCSK9 inhibitor use from 1% to 3%. And if we looked at LDL reductions, it was a 52 milligram per deciliter reduction in LDL from an average LDL of a 125 down to 73 in those folks who achieved maintenance. For blood pressure, again, in those patients whom we successfully treated who are about 600 patients, we saw a 14 millimeter systolic blood pressure reduction and a seven millimeter mercury diastolic blood pressure reduction. Dr. Greg Hundley: Wow. Well Sandeep, what drew your attention to this? And then also, how do you put the context of these results with others that really are working in this wing of data science in cardiovascular medicine? Dr. Sandeep Das: Great question. We have a large body of literature that suggests that the use of these fantastic evidence based therapies like statins, like blood pressure medications is poor and we really struggle to improve those numbers. I wanted to applaud Ben and his group for really taking on, in a robust way, an important topic and subject. The other thing that really attracted me to this study, there was a hypertension expert here named Ron Victor back when I first started as a fellow. Fantastic researcher and he did a project called Colloquia called the Barbershop Project about leveraging pharmacists and barbers to improve the blood pressure control of African American men in the community. Dr. Sandeep Das: The idea is that you get out there, you got to go to where the patients are rather than expecting them to come to you. And you got to figure out ways to engage them, activate them, get them to participate in their own care. A fantastic study, but the one thing that always, we discuss that study, the thing that always jumps out is, well how do you scale it? How do you use it in a real practice? To me was also a very exciting aspect to this. The goal is to take steps to generalize from clinical trials to real world practice, because we got to get this to patients. Dr. Greg Hundley: Very nice. Well Ben, coming back to you, what do you see as next steps for your research here? And then even in the field? Dr. Benjamin Scirica: The first is, are there other disease areas we can do this in? I think the second part is how to test different techniques to try to improve the ability to scale it to broader populations and keep the cost down. And I think it is a combination of trying to find the right tools, whether they're digital or not and the right techniques to be able to activate patients, educate them, such that they are asking the question, "How come I'm not on these medicines? How come I'm not on this?" And I think we could do a lot in terms of AB testing in there. The part that I think is challenging in these healthcare studies and quality improvement studies, is that randomization would be great. How can we do it streamline? Do we need to get consent? Can it just be that approved drug A can be tested against approved drug B because there is clear equipoise. And I think by doing that, we could lower the bar for really pragmatic randomization in practice and be able to have much more rapid cycles of improvement and optimization on therapy. Dr. Greg Hundley: Very good. Sandeep, do you have anything to add? Dr. Sandeep Das: I'll echo Dr. Scirica's called arms here that we need to have a way to do this, do trials in this space pragmatically. I agree with that strongly. I did have a few thoughts on next directions. I work in a population of the urban poor of Dallas County with a lot of my clinical time and these patients have poor health literacy so I think that one question, not question but suggestion or comment to Ben and his group would be to think hard about how you would expand this to lower resource setting or to people that would be a little harder to reach. And even as sort of an aspirational goal, how do you expand it into the community? The other question that I would have is how much of this can we get by with adherence interventions? It's one thing to prescribe, but it's another thing to figure out how to get people to adhere to meds. Dr. Greg Hundley: Very nice. Well listeners, we want to thank Dr. Ben Scirica for Brigham and Women's and Dr. Sandeep Das from UT Southwestern, bringing us this really interesting research that has been providing early results of a remotely delivered pharmacist led lipid and hypertension management strategy that dramatically increased medication compliance and improved hypertension control and lipid management. Dr. Greg Hundley: On behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021.  

Focus Issue on Valvular Heart Disease

Commentary by Drs. Sachin Goel & Nick Aroney

In this episode, Dr Katie Thomas discusses key points from a recent case report published in EHJ - Case Reports. 

This episode covers the differential diagnosis for valvular heart disease!

This episode covers the differential diagnosis for valvular heart disease.

Focus Issue on Valvular Heart Disease

Commentary by Dr. Valentin Fuster

Welcome! and Thank you for listening.  Are you hunkered down worried about COVID-19?  Are you at risk? Can you prepare? It is a great time to be plant strong.  Are we bullet proof?  Of course not.  But plant strong immune competent people can take a viral attack much better than fast food, meat eating, immunodeficient folks.   Can you exercise too much or too hard?  What do you think I will say?  I will discuss these things and a few other pearls on this episode.  I would love to meet you in person.  Join us March 28, 2020 for a full day of plant strong wellness with speakers, great plant based breakfast and lunch, cooking demonstrations, and much more.  Go to doctordulaney.com NOW and get your tickets before the price increase Monday, March 9th.  You will not regret it.   Thanks for listening!

Focus Issue on Valvular Heart Disease

Commentary by Dr. Julia Grapsa and Dr. Edgar Argulian

Dr RR Baliga's Internal Medicine Podcast for Physicians: Must Know Facts about Valvular Heart Disease Derived from Baliga's Textbook of Internal Medicine with ~1480 MCQs Not Medical Advice or opinion

Focus Issue on Valvular Heart Disease

Dr. Shahab Ghafghazi presents "Valvular Heart Disease" and focuses mainly on aortic stenosis through various definitions and case reports. Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page. Disclaimers ©2016LouisvilleLectures.org

In this episode I cover prosthetic heart valves.If you want to follow along with written notes on prosthetic heart valves go to https://zerotofinals.com/prostheticvalves/ or find the cardiology section in the Zero to Finals medicine book.This episode covers the types, procedures and sounds of prosthetic heart valves. Special thanks to www.thinklabs.com for allowing me to use with permission the heart sounds recorded on a Thinklabs Digital Stethoscope and available at www.thinklabs.com/sound-library and the Thinklabs YouTube channel.

In this episode I cover heart sounds and heart murmurs.If you want to follow along with written notes on heart murmurs go to https://zerotofinals.com/medicine/cardiology/murmurs/ or find the cardiology section in the Zero to Finals medicine book.This episode covers the physiology and pathophysiology of heart sounds, valvular heart disease and heart murmurs. This includes third and fourth heart sounds, mitral stenosis, mitral regurgitation, aortic stenosis and aortic regurgitation.Special thanks to www.thinklabs.com for allowing me to use with permission the heart sounds recorded on a Thinklabs Digital Stethoscope and available at www.thinklabs.com/sound-library and the Thinklabs YouTube channel.

Commentary by Dr. Valentin Fuster

In this episode of the Heart podcast, James Rudd is joined by Professor Catherine Otto, Editor in Chief of the journal. They discuss the latest issue of Heart that is dedicated to valve disease. Some excellent papers are discussed covering a range of conditions. Please leave a review of the podcast at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 Link to published paper: http://heart.bmj.com/content/104/10/789. Read the Heart's Special Issue on Valvular Heart Disease for free until the 30th of June 2018: http://heart.bmj.com/content/104/10.

Learn the points you need to know to prepare for the 2019 iPANRE.  Clean. Effective. 

Get the latest on valvular heart disease: TAVR vs SAVR, choice of valve type, rheumatic heart disease, antibiotic prophylaxis for endocarditis, who needs an echocardiogram, and anticoagulation goals with tips from cardiologist, Dr Eli Gelfand, Section Chief of General Cardiology at Beth Israel Deaconess Medical Center in Boston and an Assistant Professor of Medicine at Harvard Medical School. Correspondent Dr Kate Grant joins us for this conversation w/Dr Gelfand about his common sense approach to the evaluation and management of valvular heart disease. Written by Kate Grate, MD and Matthew Watto, MD. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Disclaimer 00:35 Intro 02:55 Guest bio 04:15 Getting to know our guest 12:18 Picks of the week 17:07 Clinical case of aortic stenosis 18:00 Types of valve procedures available and initial workup for valvular disease 26:11 Counseling patients about a heart murmur 29:33 Symptoms in valvular heart disease 31:07 Who needs an echo? 32:36 Who needs a referral? 34:40 Frequency of echocardiogram 36:25 Medications for valvular heart disease 39:12 Diuretics and aortic stenosis 40:40 Medication for mitral stenosis and anticoagulants in valvular heart disease 43:31 INR goals and use of ASA by valve type and position 45:23 Endocarditis prophylaxis 48:50 Rheumatic heart disease 51:55 Valvulitis and a quick history lesson 53:50 Transaortic valve replacement 57:58 Multidisciplinary teams and how to determine if valve is causing symptoms 62:14 Take home points 63:47 Closing thoughts from The Curbsiders 66:15 Outro Tags: valve, heart, disease, valvular, cardiomyopathy, failure, systolic, murmur, aortic, mitral, tricuspid, surgery, tavr, diuretic, rheumatic, stenosis, regurgitation, echo, echocardiogram, repair, replacement, inr, anticoagulation, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

In this podcast Cardiac Surgeon, Dr. Steven Meyer discusses Valvular Heart Disease. After listening to this podcast you will be able to: Define Valvular Heart Disease Discuss history and physical examination Review investigations Understand when a referral is necessary

Dr. Javier Bermejo and Dr. C. Michael Gibson Discuss

This episode covers Chapter 83 of Rosen's Emergency Medicine.   List 6 RFs for bacterial endocarditis List 5 common bacteria responsible for infective endocarditis Give three examples of immunologic sequelae of IE. Give three examples of vascular sequelae of IE. What are the diagnostic criteria for endocarditis, and how are they used? List 5 lab or investigative findings in bacterial endocarditis Describe the treatment of infective endocarditis List four complications of IE. List the indications for infectious endocarditis prophylaxis. What are the empiric antibiotics used for pts with suspected infectious endocarditis? Describe the Jones Criteria for Acute Rheumatic Fever What is the treatment of rheumatic fever Name three causes of acute mitral regurgitation. How is acute MR managed? What is the pathophysiology of mitral valve prolapse?  How does it present? List four causes of mitral stenosis. List four causes of aortic valve insufficiency. List 3 physical exam findings associated with AS What is critical aortic stenosis?Outline the ED management for a pt with critical aortic stenosis with CHF and hypotension. List 5 complications of prosthetic valves.  WiseCracks: Describe Janeway lesions Osler nodes Splinter hemorrhages Roth Spots What are the HACEK organisms, and what is their significance in pts with IE? Brief run down of all valvular disease - in one or two lines.

This episode covers Chapter 83 of Rosen's Emergency Medicine.   List 6 RFs for bacterial endocarditis List 5 common bacteria responsible for infective endocarditis Give three examples of immunologic sequelae of IE. Give three examples of vascular sequelae of IE. What are the diagnostic criteria for endocarditis, and how are they used? List 5 lab or investigative findings in bacterial endocarditis Describe the treatment of infective endocarditis List four complications of IE. List the indications for infectious endocarditis prophylaxis. What are the empiric antibiotics used for pts with suspected infectious endocarditis? Describe the Jones Criteria for Acute Rheumatic Fever What is the treatment of rheumatic fever Name three causes of acute mitral regurgitation. How is acute MR managed? What is the pathophysiology of mitral valve prolapse?  How does it present? List four causes of mitral stenosis. List four causes of aortic valve insufficiency. List 3 physical exam findings associated with AS What is critical aortic stenosis?Outline the ED management for a pt with critical aortic stenosis with CHF and hypotension. List 5 complications of prosthetic valves.  WiseCracks: Describe Janeway lesions Osler nodes Splinter hemorrhages Roth Spots What are the HACEK organisms, and what is their significance in pts with IE? Brief run down of all valvular disease - in one or two lines.

Commentary by Dr. Valentin Fuster

NUR 202 - Valvular Heart Disease - 2:20:17, 9.39 PM by Coastal Alabama Community College Biology Podcasts

In today's VETgirl veterinary continuing education podcast, we review whether Vitamin D plays a role in heart disease in dogs. Vitamin D deficiency, as determined via serum 25-hydroxyvitamin D [25(OH)D] concentrations, is associated with worsened cardiac function, heart failure symptoms, and prognosis in human heart failure patients. Supplementation of vitamin D in such patients improves cardiac function and improves prognosis. A 2014 study in dogs demonstrated that serum 25-hydroxyvitamin D concentrations are lower in dogs with CHF secondary to either CVHD or DCM than in normal dogs. So, Osuga et al out of Japan wanted to evaluate if an association exists between vitamin D status and all stages of CVHD, as well as investigate if any association exists between vitamin D status and echocardiographic parameters of cardiac structure and function in these canine patients.

In today's VETgirl veterinary continuing education podcast, we review whether Vitamin D plays a role in heart disease in dogs. Vitamin D deficiency, as determined via serum 25-hydroxyvitamin D [25(OH)D] concentrations, is associated with worsened cardiac function, heart failure symptoms, and prognosis in human heart failure patients. Supplementation of vitamin D in such patients improves cardiac function and improves prognosis. A 2014 study in dogs demonstrated that serum 25-hydroxyvitamin D concentrations are lower in dogs with CHF secondary to either CVHD or DCM than in normal dogs. So, Osuga et al out of Japan wanted to evaluate if an association exists between vitamin D status and all stages of CVHD, as well as investigate if any association exists between vitamin D status and echocardiographic parameters of cardiac structure and function in these canine patients.

On this episode we cover syncope, valvular heart disease and cardiogenic pulmonary edema. As always this podcast does not represent the views of Stroger hospital, Cook County Human Health Services or the Stroger Emergency Medicine Residency

Some studies have suggested endothelial dysfunction in adult patients after repair of aortic coarctation (CoA), and it has been proposed to play a key role in the pathogenesis of arterial hypertension in the absence of re-coarctation. A study recently published in Heart aimed to assess the presence of endothelial dysfunction, the number of endothelial progenitor cells, and the levels of proinflammatory cytokines associated with endothelial injury in contemporary patients after CoA repair. Alistair Lindsay discusses what the work revealed with lead author Robert Radke, Division of Adult Congenital and Valvular Heart Disease, Department of Cardiology and Angiology, University Hospital Muenster. Read the full paper (for free): http://goo.gl/z32cOl

Professor Vahanian, Bichat Hospital, Paris, France, is a world leader in management of patients with Valvular Heart Disease and is the lead author of the European Society of Cardiology Guidelines. In this interview, held during the Transcatheter Valve Therapeutics Meeting in Vancouver, Canada in June 2014, Professor Vahanian talks with Catherine Otto about the current approach to patient selection for transcatheter aortic valve implantation (TAVI). The availability of TAVI has transformed our approach to the elderly or high risk patient with severe aortic stenosis and the use of this technology continues to expand as technical issues are resolved and more data on valve durability is published. Clinicians will want to keep up to date on the latest information so appropriate patients are referred for this life saving treatment. To read more about transcatheter aortic valve implantation, see several recent articles in Heart: Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score http://goo.gl/lcflnl Predictors of 1-year mortality in patients with aortic regurgitation after transcatheter aortic valve implantation: an analysis from the multicentre German TAVI registry http://goo.gl/WkfmM5 Aortic regurgitation severity after transcatheter aortic valve implantation is underestimated by echocardiography compared with MRI http://goo.gl/KIo6B4 Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation http://goo.gl/YTcbaf Original article: Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI http://goo.gl/u5dK82

Dr. Vasilis Babaliaros. Interventions for Valvular Heart Disease. Recorded 2011-12-12.

Guest: Howard C. Herrmann, MD Host: Lee Freedman, MD We are increasingly able to turn to non-surgical therapies for structural and valvular heart disease. Host Dr. Lee Freedman discusses investigational, catheter-based treatment with Dr. Howard Herrmann, professor of medicine, and director of interventional cardiology and the Cardiac Catheterization Laboratories within the University of Pennsylvania Health System. What new devices are making these advances possible? What are the procedural risks?

Guest: Howard C. Herrmann, MD Host: Lee Freedman, MD We are increasingly able to turn to non-surgical therapies for structural and valvular heart disease. Host Dr. Lee Freedman discusses investigational, catheter-based treatment with Dr. Howard Herrmann, professor of medicine, and director of interventional cardiology and the Cardiac Catheterization Laboratories within the University of Pennsylvania Health System. What new devices are making these advances possible? What are the procedural risks?