Podcasts about wolff parkinson white

In this week's episode I sat down with Mariadeliz Santiago. Maria is a NYC-based disabled content creator, speaker, and advocate who uses her platform to champion authentic representation and accessibility in media. As a Latina with an upper limb difference and chronic conditions like Wolff-Parkinson-White syndrome and new daily persistent headache (NDPH), she creates impactful content that bridges beauty, lifestyle, and disability awareness. With a growing and engaged audience, Maria partners with inclusive brands to tell meaningful stories, and regularly speaks on the importance of disability visibility, intersectionality, and inclusive marketing. We discuss the rise and importance of adaptive beauty, how she uses make-up as a palette to show her creativity and express herself, beauty brands that are truly doing it right and much, much more. Join The Patreon: Click ⁠Here⁠Follow Maria: Instagram: @limbitlessmaria_ TikTok: @limbitlessmariaFollow Me: Instagram: ⁠@jill_ilana⁠ , ⁠@alwayslookingup.podcast⁠ TikTok: ⁠@jillian_ilana⁠ Website: ⁠https://www.jillianilana.com⁠ Email: ⁠alwayslookingup227@gmail.com⁠Read With Me:⁠Goodreads⁠⁠The StoryGraph⁠Relief For Disabled People Impacted By The Los Angeles Fires:Richard Devylder Disaster Relief Fund: ⁠https://disabilitydisasteraccess.org/rd-relief-fund/⁠United Spinal Disaster Relief Grant: ⁠https://unitedspinal.org/disaster-relief-grant/⁠Inevitable Foundation Emergency Relief Fund: ⁠https://www.inevitable.foundation/erf⁠This episode was edited and produced by Ben Curwin

In this episode, we're talking to the “father of cardiac arrhythmia surgery”, Dr. James Cox. The former Division Chief of Cardiothoracic Surgery here at WashU Med, Dr. Cox developed surgical procedures for multiple cardiac arrhythmias, including the Wolff-Parkinson-White syndrome, atrioventricular nodal reentry tachycardia, automatic atrial tachycardias, atrial flutter, atrial fibrillation and ventricular tachycardia. He is best known for developing the Cox-Maze procedure, the first cure for atrial fibrillation, which he performed for the first time at Barnes Jewish Hospital in 1987. Dr. Cox's contributions and developments forever changed the field of cardiac surgery and have saved countless lives. We hope you enjoy our fascinating discussion with Dr. Cox as much as we did! Title music: World Is Holding Hands by WinnieTheMoog https://creativecommons.org/licenses/by/4.0/legalcode

We review a general approach to syncope in children. Hosts: Brian Gilberti, MD Ellen Duncan, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Syncope_in_Children.mp3 Download Leave a Comment Tags: Cardiology, Pediatrics Show Notes Initial Evaluation and Management: Similar initial workup for children and adults: checking glucose levels for hypoglycemia and conducting an EKG. The history and physical exam are crucial. Dextrose Administration in Children: Explanation of the ‘rule of 50s' for determining the appropriate dextrose solution and dosage for children. ECG Analysis: Importance of ECG in diagnosing dysrhythmias like long QT syndrome, Brugada syndrome, catecholamine polymorphic V tach, ARVD, ALCAPA, and Wolff-Parkinson-White syndrome. Younger children's dependency on heart rate for cardiac output and the risk of arrhythmias in kids with congenital heart disease. Condition Characteristic ECG Findings Congenital/Acquired Long QT Syndrome (LQTS) Prolonged QT interval Congenital/Acquired Wolff-Parkinson-White Syndrome (WPW) Short PR interval, Delta wave Congenital Brugada Syndrome ST elevation in V1-V3, Right bundle branch block Congenital Atrioventricular Block (AV Block) PR interval prolongation (1st degree), Missing QRS complexes (2nd & 3rd degree) Congenital/Acquired

A client has a rare condition that might impact her ability to receive massage. A brief look shows no special cautions, but a deeper look reveals some important questions to ask. In this episode Ruth takes listeners along for the treasure hunt for useful information—not just for Wolff-Parkinson-White syndrome, but for your future use when you have a client with a condition you've never heard of.   Sponsors:     Books of Discovery: www.booksofdiscovery.com       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.                                      Recent Articles by Ruth:          “Working with Invisible Pain,” Massage & Bodywork magazine, November/December 2022, page 36, http://www.massageandbodyworkdigital.com/i/1481961-november-december-2022/38   “Unpacking the Long Haul,” Massage & Bodywork magazine, January/February 2022, page 35, www.massageandbodyworkdigital.com/i/1439667-january-february-2022/36. “Chemotherapy-Induced Peripheral Neuropathy and Massage Therapy,” Massage & Bodywork magazine, September/October 2021, page 33, http://www.massageandbodyworkdigital.com/i/1402696-september-october-2021/34.           “Pharmacology Basics for Massage Therapists,” Massage & Bodywork magazine, July/August 2021, page 32, www.massageandbodyworkdigital.com/i/1384577-july-august-2021/34.           Resources:    Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app   Ablation for Arrhythmias (no date) www.heart.org. Available at: https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/ablation-for-arrhythmias (Accessed: 13 December 2023).   Athletic Screening (no date) 1-to-1 Pediatrics. Available at: http://www.1to1pediatrics.com/athletic-screening.html (Accessed: 13 December 2023).   Chhabra, L., Goyal, A. and Benham, M.D. (2023) ‘Wolff-Parkinson-White Syndrome', in StatPearls. Treasure Island (FL): StatPearls Publishing. Available at: http://www.ncbi.nlm.nih.gov/books/NBK554437/ (Accessed: 13 December 2023).   Massage & Bodywork - NOVEMBER | DECEMBER 2020 (no date). Available at: https://www.massageandbodyworkdigital.com/i/1299745-november-december-2020/40? (Accessed: 13 December 2023).   Patient Education: Wolff-Parkinson-White Syndrome (Beyond the Basics). Available at: https://www.uptodate.com/contents/wolff-parkinson-white-syndrome-beyond-the-basics. (Accessed: 13 December, 2023).   Screening in Sport (no date) Physiopedia. Available at: https://www.physio-pedia.com/Screening_in_Sport (Accessed: 13 December 2023).   Vagal Maneuvers with Supraventricular Tachycardia (no date) ACLS.com. Available at: https://acls.com/articles/vagal-maneuvers/ (Accessed: 13 December 2023).   What Is Wolff-Parkinson-White Syndrome? (no date) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/17643-wolff-parkinson-white-syndrome-wpw (Accessed: 13 December 2023).   ‘Wolff-Parkinson-White Syndrome: Practice Essentials, Background, Pathophysiology' (2022). Available at: https://emedicine.medscape.com/article/159222-overview (Accessed: 13 December 2023).  

WPW in Athletes Guest: Guru Kowlgi, M.D Host: Anthony H. Kashou, M.D. (@anthonykashoumd) In this episode, we'll explore Wolff-Parkinson-White, WPW syndrome in athletes. We're excited to have Dr. Guru Kowlgi as our esteemed guest and expert in this field and friend of ours. Our focus will be on the concerns associated with WPW Syndrome, the identification of individuals at risk of sudden death, and the treatment approaches for these patients. WPW Sudden Death in Athletes Treatment options Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

In this episode, Wes and Todd sit down with Multimedia Artist, Georgia Padilla. Georgia discusses growing up in Colorado and Manitou Springs, CPTSD, living with Wolff-Parkinson-White syndrome, art as a coping mechanism, anxiety, Dialectical behavior therapy, breathing beads, mental illness, her voice as an Artist and how she uses it, how art saved her life and how it heals, becoming a professional Artist, getting into Next Gallery and being awarded a Next Gallery scholarship, all the mediums that she works in, her relief work, commissions, Etsy, craft fairs, collaborating with her daughter Daemonia for their exhibition “Coloring Outside the Lines”, Autism Acceptance Month, Autism, inclusivity, stimming, Autistic traits between genders, scripting, the three different levels of Autism, Applied Behavior Analysis, making visuals, setting up her daughter for success, neurodiversity, and her journey to meaningful connection with her daughter through art.  Join us for an educational conversation about art, Autism and celebrating neurodiversity with Georgia Padilla. Go see “Coloring Outside the Lines”, Georgia and Daemonia's collaborative exhibition at Next Gallery.“Coloring Outside the Lines”March 31-April 16, 2023Next Gallery – www.nextgallery.orgOpening night March 31st from 5-10pm Follow Georgia Padilla on social media:On Instagram - www.instagram.com/georgiascustomart/@georgiascustomartOn Facebook - www.facebook.com/artbyGeorgiaPCheck out Georgia's Etsy shop at www.etsy.com/shop/GeorgiasCustomArt

Cardio: 6. Harry and Dan talk about SVTs, recognising them clinically and their management. This episode also covers Wolff-Parkinson-White syndrome. This episode was vetted by a Consultant Cardiologist (who wishes to remain anonymous) at the Royal Brompton & Harefield NHS Trust, London. Links: An example of an ECG showing SVT SVT example 1a https://litfl.com/supraventricular-tachycardia-svt-ecg-library/ An example of an ECG showing WPW pattern Example 2 https://litfl.com/pre-excitation-syndromes-ecg-library/ Modified Valsava technique from the REVERT Trial link https://www.youtube.com/watch?v=8DIRiOA_OsA Resus council adult tachycardia algorithim (2021) https://www.resus.org.uk/sites/default/files/2021-04/Tachycardia%20Algorithm%202021.pdf Key resource used (but frankly, this provides detail far beyond what is expected for medical school): Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia: The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(5):655-720. doi:10.1093/eurheartj/ehz467

1.27 Wolff-Parkinson-White Syndrome   Cardiovascular system review for the USMLE Step 1 exam.

In this episode, we review the high-yield topic of Wolff-Parkinson-White (WPW) Syndrome from the Cardiovascular section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

In this episode, we review the high-yield topic of Wolff-Parkinson-White (WPW) Syndrome from the Cardiovascular section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

WPW or Wolff Parkinson White Syndrome is a genetic heart defect 1-3 out of 1000 people are born with but most don't know they have it until it's too late.  Listen to my personal experience with how I "accidentally" found out my daughter had it at age 7,  and how divine intervention played a role in saving her life. Based on Article: (Click here for links & photos of EKG & Heart with WPW)https://hubpages.com/health/Do-You-or-Your-Child-Have-Wolff-Parkinson-White-Syndrome eBay Goodies:https://www.ebay.com/usr/rosanamodYoutube Channel:SUBSCRIBE & CLICK THE NOTIFICATION BELL TO STAY UP TO DATE!https://www.youtube.com/watch?v=bziGGJ1PfBc&t=209sBooks: https://www.amazon.com/Crow-Flies-Midnight-Husbands-Betrayal-ebook/dp/B00J2F8SBWhttps://www.amazon.com/Crucified-Spirit-Collection-Tormented-Poetry/dp/1495923630 Articles:https://hubpages.com/@rosanamodugnoFollow Me on Instagram: https://www.instagram.com/rosanamod/  Podcast Website:https://rosanamod.buzzsprout.com/Instacarthttps://instacart.oloiyb.net/c/2473097/413183/7412Love the show?  Click below & thank you for your support!https://paypal.me/RosanaMod?locale.x=en_US

Wolff-Parkinson-White syndrome occurs when someone has an accessory pathway through which electrical signals can travel in the heart and bypass the AV node or travel backwards from the ventricles to the atria. WPW can cause supraventricular and ventricular tachycardias. The definitive treatment is ablation of the accessory pathway.   Links and resources: Follow us on Instagram @yourekiddingrightdoctors Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don't miss any episodes and RATE to help other people find us! (This isn't individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)

#628- Tudo sobre Síndrome de Wolff-Parkinson-White em 12 minutos. by Cardiopapers

Our cardiologists Dr Peter Larsen and Dr Stuart Butterly discuss Wolff-Parkinson-White (WPW) syndrome and Myocarditis.WPW is a rare condition, caused by a problem with the heart's electrical system, that can cause a fast and irregular heartbeat. Peter discusses a recent case of WPW that he detected at Heart HQ.Myocarditis has been in the news lately as rare cases have been reported after the Pfizer or Moderna Covid-19 vaccines. Peter and Stuart discuss these cases and what they mean for those with existing heart conditions.You can view the show notes for this episode here. If you enjoyed this podcast, we'd love for you to leave a review.Remember to follow us on Facebook, Instagram and LinkedIn.If you'd like to get in touch with us about our podcast, you can email us at podcast@hearthq.com.auWe use Buzzsprout to bring you this podcast. From FREE training courses to set up your podcast, all the way through to podcast hosting and promotion, Buzzsprout is the only podcast partner you need! Click here for details. 

Good Philanthropy, Faheem and Nelly J chat with special guest Benarge Igwe @BenargeO) • Director of Operations • Humanitarian • Host of Wealth Wednesdays • Founder of The Wé http://www.TheWé.com "Philanthropy, Relationships & Wealth Creation" This episode we start by introducing Nelly J's brother to the podcast with his take on Kanye West DONDA versus Drake's Certified Boy albums and his NFL fantasy draft strategy for this season. We then discuss the Forbes world's highest paid athletes list and break down the importance of off-the-field earnings for some of the most elite athletes. We then weigh in on Lamarcus Aldridge's proposed return to the NBA after a heart abnormality (Wolff-Parkinson-White syndrome) sidelined his career last season. We then highlight Benarge Igwe during our FOR THE CULTURE segment who discusses the importance of financial literacy, his ongoing IG Live series "Wealth Wednesdays". We then conclude Episode 56 with THAT'S ABSURD to discuss Nerlans Noel's choice to sue former agent Rich Paul and how it may impact agents going forward. Please comment and share your thoughts, thanks for taking the time to watch or listen to the episode GOOD ROOKIES. DO GOOD and BE GOOD. Do you have a great topic suggestion? Please email us goodrookiespodcast@gmail.com

Remember the WPW Triad 1. Short PR Interval 120ms 3. Delta Wave *This is WPW pattern, patients that present symptomatic then have WPW syndrome.* Image Sources   WPW EKG- Notice the slight upstroke into the QRS complex, that's the delta wave! Image Sources   Treatments-  Most people will be asymptomatic with just WPW pattern, monitor for any tachycardia and hypo perfusion. Symptomatic patients receive synchronized cardioversion, remember UNSTABLE GETS THE CABLE!   WPW does not receive ABCD! Adenosine Beta-Blockers Calcium Channel Blockers Digoxin   SUBSCRIBE AND LEAVE A RATING ON ITUNES!!!   If you have any questions please feel free to contact me at pushdosemedic@gmail.com

Listen as Dr. Gary Dhillon reviews Wolff-Parkinson-White syndrome and pearls for the anesthesiologist and intensivist. Initial publication: February 9, 2021. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Contributor: Peter Bakes, MD Educational Pearls: Two main differentials for wide complex tachycardia (WCT) include ventricular tachycardia (most common) and supraventricular tachycardia with aberrancy Brugada syndrome and Wolff-Parkinson White are potential causes Arrhythmogenic right ventricular dysplasia is a rare congenital cause of WCT that should be considered in younger patients presenting with WCT References B Garner J, M Miller J. Wide Complex Tachycardia - Ventricular Tachycardia or Not Ventricular Tachycardia, That Remains the Question. Arrhythm Electrophysiol Rev. 2013;2(1):23-29. doi:10.15420/aer.2013.2.1.23 Katritsis DG, Brugada J. Differential Diagnosis of Wide QRS Tachycardias. Arrhythm Electrophysiol Rev. 2020;9(3):155-160. doi:10.15420/aer.2020.20 Li KHC, Bazoukis G, Liu T, et al. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in clinical practice. J Arrhythm. 2017;34(1):11-22. Published 2017 Dec 21. doi:10.1002/joa3.12021 Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

In this episode, we tackle a group of tachyarrhythmias known as paroxysmal supraventricular tachycardias, or pSVTs. This family includes atrioventricular nodal re-entry tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT), and is related to the Wolff-Parkinson-White syndrome. Learn how these arrhythmias come about in the first place, then how to recognize them and ultimately treat them. There's more to pSVTs than the buzzwords; come hear for yourself!

This episode covers wolff-parkinson-white syndrome!

Hi everyone, this week I am speaking with Alan Knowles, husband, co director, Chair of the PDG and the 2020 winner of the Protection Review's Protection Adviser of the Year. Alan is doing an income protection masterclass, talking about how versatile these policies are and how they can sometimes have a bad rep, for not being particularly accessible. But, Alan goes through 4 case studies that show how speaking with an adviser, can truly help people with higher risks to get income protection.   The key takeaways: A case study of income protection for someone with Wolff-Parkinson-White syndrome and type 1 diabetes. A case study of income protection for a person living with bipolar disorder. A case study of income protection for a rock climber. A case study of income protection for someone living with Antiphospholipid Syndrome.   Next week, will be the last episode of series 2 and we have some exciting changes coming up for season 3 in 2021. I'm going to be chatting with Matt Rann about his career in underwriting, discussing how underwriting has changed over the last 40 years. Remember, if you are listening to this as part of your work, you can claim a CPD certificate on our website.

CDC modifies contact time for close contact with COVID-19 recommendations because of prison guard infections; A superspreader event in Boston was a biotech conference in February; Dr. Dawn proposes distributing patriotic flag masks to counter the anti-mask crowd; Avastin drug improves smooth knee cartilage regrowth from cartilage stem cell injections; Improvements in stem cell treatments for Parkinson's disease; Longevity and other side effects of metals in dental implants; About scintillating scotomas, with and without migraine headaches; Drugs to avoid if you have the fast heart rate condition, Wolff-Parkinson-White syndrome; Discussion of the safety of air travel in the COVID-19 world; Telehealth comments and an explanation of the problems of bisphosphonates to treat osteoporosis; Exciting new discovery of a pair of salivary glands in the back of the throat! Sensitivities for cancer linked to cell phones may depend on particular SNPs; Certain genetic variations in the immune system explain more extreme reactions to Coronavirus in children

CDC modifies contact time for close contact with COVID-19 recommendations because of prison guard infections; A superspreader event in Boston was a biotech conference in February; Dr. Dawn proposes distributing patriotic flag masks to counter the anti-mask crowd; Avastin drug improves smooth knee cartilage regrowth from cartilage stem cell injections; Improvements in stem cell treatments for Parkinson's disease; Longevity and other side effects of metals in dental implants; About scintillating scotomas, with and without migraine headaches; Drugs to avoid if you have the fast heart rate condition, Wolff-Parkinson-White syndrome; Discussion of the safety of air travel in the COVID-19 world; Telehealth comments and an explanation of the problems of bisphosphonates to treat osteoporosis; Exciting new discovery of a pair of salivary glands in the back of the throat! Sensitivities for cancer linked to cell phones may depend on particular SNPs; Certain genetic variations in the immune system explain more extreme reactions to Coronavirus in children

Drummer Jochen Rueckert has some things to get off his chest.  Born and raised outside of Cologne, Germany, Rueckert started coming to New York as soon as he possibly could. By the time he was in his early 20s, he was already well into paying his dues. He can be heard on over 120 albums and worked or recorded with musicians and bands such as the Marc Copland Trio, the Kurt Rosenwinkel new quartet, the Mark Turner Band, the Melissa Aldana trio, the Sam Yahel trio, John Abercrombie, Pat Metheny (he tells that story here), Matt Penman, Kenny Werner, Bill McHenry, Seamus Blake, Guillermo Klein and Los Guachos as well as Madeleine Peyroux. He also leads his own band, programs and releases electronic music under the moniker Wolff Parkinson White, and has written a series of ebooks chronicling every hotel room he's stayed at with a self-timer photograph and short stories about some of the more annoying aspects of life as a touring musician, called Read The Rueckert. In this extensive and wide ranging conversation Rueckert meditates on his early years in Germany, why playing with great bass players is like eating great pasta, refusing to share hotel rooms, why he is a reluctant teacher, making electronic music, the rare innate heart condition he suffers from, how to groove with organ players, organizing tours, why one should never play with pop musicians, what it was like to play one gig with Pat Metheny, what he’s thinking about when he performs, drummer Bill Stewart’s time feel and volume level, Artificial Intelligence, the years he spent at Nublu in the Lower East Side of Manhattan, and much, much more. www.third-story.com www.leosidran.com www.jochenrueckert.net/

BROADCAST YOURSELF - 8 Week Course: https://londonreal.tv/by/ 2021 SUMMIT TICKETS: https://londonreal.tv/summit/ NEW MASTERCLASS EACH WEEK: http://londonreal.tv/masterclass-yt LATEST EPISODE: https://londonreal.link/latest Flashback to almost the beginning of London Real in 2013 as UFC Mixed Martial Artist Dan Hardy drops by London Real to talk about his storied fighting career, his experiences with the psychedelics ayahuasca and psilocybin, and his recent diagnosis with Wolff-Parkinson-White syndrome AKA his Wolf Heart and if it means the end of his fighting career.

This week's edition of Into The Vault features Creaming Jesus!Playlist: lié - All Night LongSpectres - Pictures From Occupied EuropeBody Lens - BLPThe Birthday Massacre - EnterParagon Cause - Lost CauseCreaming Jesus - CasseroleCreaming Jesus - ReptileCreaming Jesus - Celebrity CannibalismAversions - Night ClassCable Ties - HopeWild Nothing - Sleight Of HandBambara - SweatAnna Calvi - Indies Or Paradise (Hunted Version)Sightless Pit - The Ocean Of MercySigsaly - OSmaller Hearts - Perennials (Remix)Game Genie Sokolov - Coming OutHolosapien - DisgraceMagic Sword - ProphecyNETRVNNER - The Light Of The TreesBoniface - Stay HomePOSTNAMERS - CrownsArtifiseer - ZealWolff Parkinson White, featuring Desmond White - Neon FaithfulAlder and Ash - FeverlingMike Hodsall - Mellotron Space WarpAbsentia - AttritionSungaze - Washed AwayHollow Oax - The Darkness

Wolff-parkinson-white syndrome

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr Greg Hundley: I'm Greg Hundley, associate editor from the VCU Pauley Heart Center in Richmond, Virginia. Dr Carolyn Lam: Greg today's speaker paper is all about soy products and whether or not there is a benefit with them with regards to risk of coronary heart disease. Now, this has been extremely controversial and today's speech or paper is really important in its findings. Ha ha, I bet you want to get to it right now but I'm going to say, hold on let's get to some other really interesting papers in this series first. Can I start off? You got your coffee? Dr Greg Hundley: Yes. Let's get going Carolyn. Dr Carolyn Lam: So the first paper I want to highlight really talks about myocardial energetics in obesity, and you're going to love this one Greg it's got some really cool MRI techniques. We know that obesity is strongly associated with exercise intolerance and the development of heart failure particularly HFpEF. Well Dr Rayner from University of Oxford and colleagues looked at this carefully in 80 volunteers, which included 35 controls with an average BMI of 24 and 45 obese individuals with an average BMI of 35, who did not have coexisting cardiovascular disease. Now, these participants underwent body composition analysis and MRI of the abdominal liver and myocardial fat content, left ventricular function and 31 Phosphorus Magnetic Resonance Spectroscopy to assess Phosphocreatine ATP and Creatine Kinase Kinetics at rest and during Dobutamine Stress. Dr Greg Hundley: Oh, wow Carolyn, this is right up my alley. You've got MRI imaging for body composition coupled with MR spectroscopy for metabolism, so what did they find? Dr Carolyn Lam: Thanks for putting that simply for us Greg. They found that in the obese resting heart, the myocardial creatine kinase reaction rate is increase, maintaining ATP delivery despite reduced energy stores during increased workload. While the non obese heart increases ATP delivery through creatine kinase the obese heart does not, and this is associated with reduced systolic augmentation and exercise tolerance. Weight Loss reversed these energetic changes, so these findings really highlight myocardial energy delivery via creatine kinase as a potential therapeutic strategy to improve symptoms in obesity related heart disease, as well as a fascinating modifiable pathway involved in the progression to heart failure. Now with this paper the central illustration is so critical, everybody has to pick up that issue and have a look. Furthermore, you must read the elegant editorial by Barry Borlaug and Craig Malloy. Dr Greg Hundley: Oh, you bet Carolyn. Craig always puts these MR spectroscopy papers in such fantastic perspective, really looking forward to that read and such an elegant study. Now, we haven't had Carolyn's quiz in weeks and we're going to get into one. This paper comes from Professor Nina Wettschureck, from the Max-Planck-Institute for Heart and Lung research, and it pertains to the infamous G-protein coupled receptors. Now, Carolyn here's your quiz and guess what, it's just multiple choice. All you have to do is fill in the blank. Dr Carolyn Lam: On G-protein coupled receptors? Dr Greg Hundley: Yeah, I know it's... we know a lot about these, but we're going to learn. So, G-protein coupled receptors are the largest family of transmembrane receptors in eukaryotes. They transduce signals of numerous physio-chemical stimuli including... and Carolyn you have to complete this sentence. So it's neurotransmitters, hormones, local mediators, metabolic or olfactory cues and got to complete the sentence. Is it air resistance? Time? Or light? Dr Carolyn Lam: Space. Dr Greg Hundley: That's not a choice. Dr Carolyn Lam: All right, all right let me guess light. Dr Greg Hundley: That's awesome. Fantastic, great job Carolyn. So in the vascular system the contract alternative vessels is crucially regulated by these GPCRs, including basic constrictors such as Angiotensin two and Endothelin one. In this study the investigators studied the role of GPRC5B, and the regulation of contractility and differentiation in human and murine smooth muscle cells in vitro, as well as in tamoxifen inducible smooth muscle cells Pacific knockout mice under conditions of arterial hypertension and atherosclerosis, and these experiments were done in vivo. Dr Carolyn Lam: Okay, so what were the results? Dr Greg Hundley: They found that GPRC5B regulates vascular smooth muscle tone and differentiation by negatively regulating prostate cycling receptor signaling. Thus, Carolyn inhibition of the interaction between GPRC5B and the prostacyclin receptor might be beneficial in human arterial hypertension and vascular remodeling. What a great new insight into basic science. Well, let me get on I have a clinical paper, and this is on the infamous topic from the COMPASS-PCI trial, Rivaroxaban plus Aspirin versus Aspirin alone in patients with Prior Percutaneous Coronary Intervention from Dr Kevin Bainey at the Canadian VIGOUR Center in University of Alberta. So Carolyn, the cardiovascular outcomes for people using anticoagulation strategies or COMPASS trial demonstrated dual pathway intervention with Rivaroxaban 2.5 milligrams twice daily plus aspirin, and 100 milligrams once daily versus aspirin 100 milligrams once daily, reduced the primary major adverse cardiovascular event outcome of cardiovascular death, MI or stroke as well as mortality in patients with chronic coronary syndromes or peripheral arterial disease. Now, whether this remains true in patients with a history of PCI is unknown. Dr Carolyn Lam: Oh, Greg I'm so disappointed. Why didn't you give me a quiz here? I know about the COMPASS trial. Okay, so what did the author's find? Dr Greg Hundley: So Carolyn of the 27,000 plus patients in COMPASS 16,500 plus patients had chronic coronary syndrome, were randomized to DPI or aspirin and of these 9,862 had prior PCI. So here are the results, DPI compared with aspirin produce consistent reductions in MACE mortality, but with increased major bleeding with or without prior PCI. So among those with prior PCI one year and beyond, the effects on MACE and mortality were consistent irrespective of time since the last PCI. Dr Carolyn Lam: Mm-hmm (affirmative) Interesting implications on dual platelet inhibition. Well, let me tell you a little bit about what's in the mailbag in the rest of this issue. There's a research letter by Dr Joseph Wu on molecular signatures of beneficial class effects of statins on human induced pluripotent stem cell derived cardiomyocytes. We have global rounds by Dr Annika Rosengren and Dr Lars Wallentin on the cardiovascular medicine in Sweden. We have a White Paper by Dr Abhinav Saxena and colleagues on the value of hemodynamic monitoring in patients with cardiogenic shock undergoing mechanical circulatory support. And we also have paired perspective pieces, one by Dr Salim Virani and colleagues on secondary prevention of atherosclerotic cardiovascular disease comparing recent United States and European guidelines on dyslipidemia, and another by Dr Neil Stone and colleagues on comparing primary prevention recommendations with the focus look at the US versus European guidelines on dyslipidemia. Dr Greg Hundley: Very good, Carolyn. Well, I've got a research letter Professor Do-Young Kwon from the Korea University of Ansan Hospital, Korea University College of Medicine and discusses the association of Parkinson's disease with the risk of cardiovascular disease and all-cause mortality, and a nationwide population-based cohort study. In addition, different series of letters Dr Seung-Jung Park from Asan Medical Center at the University of Ulsan College of Medicine, and Professor Lang Li of The First Affiliated Hospital of Guangxi Medical University exchanged letters regarding the article, Clinically Significant Bleeding With Ticagrelor versus Clopidogrel in Korean patients with Acute Coronary Syndromes Intended for Invasive Management, that previously published randomized clinical trial. Then finally one of those great ECG investigations from Dr Miguel Arias, and they have an ECG quiz entitled The Hidden Reveals the Hidden, but really, it's referring to a Brugada ECG pattern and a patient with Wolff-Parkinson-White. I can't wait to get onto that feature article discussing the potential benefits or harms of soy in men and women as it relates to cardiovascular disease. Dr Carolyn Lam: Yeah, you and I Greg let's go. Oh, boy today's feature paper really literally cuts close to the heart for me talking about soy products, and whether or not there's a relationship with cardiovascular health. This remains controversial but thankfully we've got really great data just published in this week's issue, so proud to have the first author with us Dr Qi Sun from Brigham and Women's Hospital, as well as our associate editor who's also an editorialist for this paper and that's Dr Mercedes Carnethon from Northwestern University Feinberg School of Medicine. So welcome both I cannot wait to just jump right into it. Please, Qi, tell us what you found about soy products. Dr Qi Sun: First off this is a prospective cohort study that included three cohort studies, the Nurses’ Health Study and the Nurses’ Health Study II and Health Professionals Follow-Up Study. So those three big prospective cohort follow up studies. Now over the years we have collected much data of diet which has been repeated, reviewed, and assessed over the years, and we have accumulated many cases of cardinal heart disease the numbers are a solid. Now what we found is that the intake isoflavones which are the big family are flavonoids, the higher intake of isoflavones were associated with a lower risk of developing coronary heart disease in those three cohorts of men and women. And in addition because tofu and soy milk are the primary contributor in our guide of isoflavones, we also examine the tofu and soy milk in relation to the risk of cardinal heart disease What we found is that tofu intake is significantly associated with lower risk of developing heart disease, and soy milk is also associated with lower risk of developing heart disease. It's just the association for soy milk, soy milk is not significant. And I think very interestingly we also found that the menopausal status and the postmenopausal hormone use somewhat also modulated association primarily for coffee intake with heart disease risk, in that we found younger women who were before their menopause and also postmenopausal women who did not use hormone will benefit more from tofu intake. In contrast, for postmenopausal women who are using hormone the association was not significant. I think those are the primary findings of our prospective cohort study. Dr Carolyn Lam: Oh my goodness, hallelujah. That's really marvelous and beautifully summarized, Mercedes please explain why was this such a controversial area before? And what does this paper add? Love your editorial by the way. Mercedes Carnethon: We hear a lot about nutritional epidemiology studies, and we have a lot of debates about what we should believe, whether we should change our behavior based on these observational studies and quite often we have discussions about what's new. And I lean on that final point about why I like this particular paper so much, and that's because I found the topic of isoflavones, tofu intake and soy to be extremely relevant to a large proportion of the world's population, whose primary protein intake may be something made from a soybean, heavy and isoflavones. Within the United States it's also relevant even though a smaller proportion of our population relies primarily on vegetarian diet, there is a very large and interested group wondering whether soy intake is safe. There have been discussions about whether there's harm associated with it, and the possibility that it could have beneficial influence on our leading causes of death of coronary heart disease. So I was most thrilled about the innovation of this particular topic, and its methodological rigor. When we think about what we lean on, we lean on large studies, we lean on multiple events and the size of the study allowed the investigators to explore numerous subtleties. Subtleties such as that reported related to the moderation by menopausal status, and that was the point I was most curious about and why I'm really excited to have an opportunity to talk to you today Chi. Can you tell me a little more about the menopausal status finding? Dr Qi Sun: So first off as I mentioned tofu intake was more strongly associated with lower risk of developing heart disease among younger pre-menopausal women, or postmenopausal women who did not use ham. Before that I want to also mention for isoflavones intake where I also found a similar pattern in that isoflavones are more. Appear to be more strongly associated with lower risk also in those two groups of women, although the past by interaction was non-significant. Now in terms of why I think there are a couple reasons why is that, among postmenopausal female or in our use hormone, the isoflavone can function as estrogen and provide at least partially the estrogenic effects that were calculated in postmenopausal women who do not use hormone, and for premenopausal women we think that's probably because before menopausal, the activity of estrogen receptor may be higher than the estrogen receptor after menopausal. So, in reality, the other variables of isoflavones may provide estrogen effects after menopausal. So those are the hypotheses although I have to mention that those hypotheses, we need more evidence to really shed light on the mechanisms underlying those interactions between menopausal status, postmenopausal hormonal use, where's the intake of isoflavones and tofu. Dr Carolyn Lam: So Chi I love that explanation and giving it some biological possibility, although as you said it's a postulation. But may I ask so what's the implication for men? I lived with a man who thinks if he takes soy he's going to grow boobs. So what... did you see any sex differences and do studies like this and able looking for the downsides of eating soy? Dr Qi Sun: As a scientist I'm open to any kind of new findings as long as the findings are from well conducted, rigorously designed study. But having said that I couldn't exclude the possibility that maybe soy intake is associated with certain adverse health outcomes, but so far based on my experience I didn't see any such evidence. But having said this I always say I wouldn't risk any possibility, but coming... circling back to the coronary heart disease we really didn't see much difference between men and women. It's true for the younger women we saw a stronger association but for men I also see a lower risk of heart disease. So there's a kind of interesting image on soy intake or isoflavones intake in the United States that people believe they are estrogen so a man shouldn't take it, but if you look at the group of vegetarians, the vegans. There are a lot of guys they practice vegetarian, they practice vegan diets and we also publish on plant-based diet in relation to coronary heart disease and lot of men eat very healthy. And we found those people who practice those kinds of healthy diets, soy is often mouthful of primary sources of proteins and if you look at their risk of developing heart disease, type two diabetes is quite low. Something lower than other normal women who practice otherwise omnivore diet. Dr Carolyn Lam: It's true Qi soy intake could also be a marker of a healthier lifestyle in general, by extension of what you just said. But Mercedes I love that you discuss quite a number of these issues in your editorial and at the end of the day you asked the most important question, what does this mean for us? Should we all be increasing our intake of soy products? Could you give us your synthesis of that? Mercedes Carnethon: Yes, a point that I've definitely tried to make here, and this is really in response to what I expect to be the media fear surrounding new dietary findings. One of the first questions that I know that she and his colleagues will be asked is, should I change my diet? Can I extend my life? And that's because the media is really looking for a lot of sensational headlines in this topic, and I think we have to focus on what we learn from these observational studies. They're a very important step in the scientific process that helps us provide a justification for later clinical trials, that helps us think about the multiple components that work together to promote overall excellent health. And the point you were making right before this about the individuals who eat plant based diets that are heavily based in soy. In the paper it also describes that those individuals exercise more, they may have lower intakes of saturated fat, and so I think ultimately what I take from this at least for myself and for people who would ask is that an overall healthy diet seems to stand up very well in these well done observational studies. And that soy in particular may be a part of an overall healthy diet given what we're seeing here in this very well done study. Dr Carolyn Lam: Oh, that's beautifully put Mercedes and Chi perhaps I can give you the last word. What would you say is the take home message and what are next steps? Dr Qi Sun: I think the core message is this as Mercedes very well discussed, I think soy and especially tofu can be really good components of the overall healthy plant based diet, and by practicing that I think we can significantly reduce the risk of developing coronary heart disease for both men and the women. I think moving forward we would like to see evidence from clinical trials that target cardiometabolic risk factors as outcome, and to see whether increased consumption of tofu and isoflavones can really reduce those risk markers so that they have ample evidence to support the mechanisms. As you mentioned Carolyn that this is an initial study, and it could be soy, intake could be just macro how is it, through clinical trials, we can really control those confounding factors and really provide good evidence to support our findings. Dr Carolyn Lam: Well, in the meantime I just have to say you made my day this is coming from a soy eating vegetarian, so thank you so, so much. Thank you, listeners for joining us today. Dr Greg Hundley: This program is copyright the American Heart Association 2020.  

Braden Lawyer shares how Wolff-Parkinson-White syndrome changed his relationship with Christ at Christ Community Church in Shelbyville, KY on February 9, 2020.

Listen as Dr. London Smith (.com) and his producer Cameron discuss Wolf-Parkinson-White Syndrome with call-in guest Alexandra. Not so boring! http://www.londonsmith.com/jockdocpodcast/15-wolff-parkinson-white-syndrome-alexandra/ Performed by: London Smith, Cameron Clark, Alexandra Smith, Dylan Walker. Written by: London Smith, Cameron Clark, Alexandra Smith, Dylan Walker. Produced by: London Smith, Cameron Clark, Dylan Walker. Created by: London Smith

Video version https://youtu.be/abGsk9x7ax0Non-Invasive EPS – Fact or Fiction? We’ve already discussed the use of CRM devices to monitor and manage arrhythmias, but what about using the leads to gain more information about the root cause of the problem? We can use the information from the separate leads during, for example, a tachycardic event to analyse and really find out what’s happening to the patient. This is good for the patient as it can mean avoiding further invasive EP studies, and helpful for us because we can make a more informed and timely decision about treatment routes. One of the first things we’re taught when learning to interpret EKGs is not to trust the machine’s report without checking it out for ourselves (STEMI or LVH, anyone?); maybe we should take that a little further and make sure we agree with our CRM devices!Let’s start with an example – the arrhythmia report here tells us we’re looking at an episode of VT, but we notice that the atrial and ventricular rates are around the same rate – 144/145bpm. The A-sensed lead and V-sensed lead show that we start off with A-paced beats followed closely by V-paced beats… all good so far. Then we see that the episode of tachycardia starts with a premature atrial beat – and we know that VT typically starts with a ventricular premature beat. Is this really VT? Could it be SVT? Then we see a run of atrial premature beats, each followed – eventually – by a ventricular beat. So it looks like we’re seeing an atrial rhythm with a very – VERY – slow pathway. Our atrial premature beat did have a V-paced beat afterwards, but the conduction pathway is so slow… could the premature beat have blocked the fast pathway, forcing conduction through a slow pathway with retrograde fast pathway conduction? So we now have a slow-fast SVT; typical of atrio-ventricular nodal re-entry tachycardia (AVNRT). With AVNRT we have a re-entry circuit going round the AV nodeNow, this patient has a device with an atrial electrode and a ventricular electrode, and these devices have the capacity to do basic EP studies without any further invasive procedures. So we can use this device alone to further our understanding of the patient’s needs, with none of the risks or costs associated with traditional EPS. Wonderful!Here we have a report from a St. Jude’s dual chamber pacemaker in a female patient who was admitted to hospital with serious symptomatic palpitations and pre-syncope. We had been unable to catch one of these episodes on a 12-lead EKG, but they were convincingly cardiac, at high risk of causing injury to the patient, and so we really needed to consider treatment. Should we do EP studies with a view to finding a source of arrhythmia and ablating? Traditional EP studies, although generally very safe, are not without their risks. It’s an invasive procedure where we introduce tubes through a blood vessel into the heart. There’s a risk of bleeding at the insertion site, and a risk of trauma anywhere en route to or within the heart. Although they’re done in aseptic conditions we can’t rule out the possibility of infection, and in this case the patient had a known blood-borne virus which always increases the risks to the staff involved in her care.Luckily, we knew that this woman had a dual-chamber pacemaker, with an atrial and a ventricular lead. In this case we were able to use her pacemaker to do an atrial drive at 700milliseconds – we can see two beats conducted from the atrium to the ventricles… then we initiate a premature atrial beat which actually triggered 8 beats of SVT – supra-ventricular tachycardia. At this point the patient confirmed that this had reproduced her symptoms of palpitations and feeling pre-syncopal. So we were able to make a diagnosis, based only on EP studies conducted through her already implanted device, of AVNRT. We can see that her premature atrial beats took a long time to conduct, so we think they’re going down a slow pathway to the ventricle, then with a dual nodal pathology - following a refractory phase - are returning to the atrium via the fast pathway and looping round until terminated. We could also consider the possibility of an atrial tachycardia, but we know that atrial tachycardia doesn’t typically terminate in the atrium unless with an ectopic premature atrial beat. What we have here terminates with an normal atrial beat with a usual morphology complex - unlikely to be an atrial tachycardia.What could we do in the cath lab to help confirm our diagnosis and plan management? We need to reinduce the tachycardia and try pacing it from the ventricle slightly faster than the atrial tachycardia had been. Once we stop pacing the ventricle, we can see a V-beat… then an A-beat… then a V-beat. Such a V-A-V response, according to Morady in his famous paper is most likely to be AVNRT or AVRT – atrioventricular re-entry tachycardia involving an accessory pathway, such as in Wolff-Parkinson-White syndrome. If we’d been looking at atrial tachycardia we’d expect to see V-A then another A then V. We’d see the drive for the tachycardia coming truly from the atria so we’d see more atrial than ventricular beats sensed.How can we tell from this whether it’s an AVNRT or an AVRT’s accessory pathway? We need to measure the PPI – the post-pacing interval. If we take the time between the last paced beat in the ventricle to the next beat in the ventricle and subtract it from the tachycardia cycle length (TCL) we’ll see the distance our entrainment location is from the tachycardia. The distance of this PPI minus TCL tells us more about what we’re seeing: if it’s less than 110 milliseconds, it’s most likely an accessory pathway – the ventricle is involved in the tachycardia, close to the circuit in the accessory pathway. However if its above 110milliseconds, it’s likely to be AVNRT; we’re further from the tachycardia circuit as the circuit is within the atria/AV node so when we pace from the ventricle we’re waiting for the impulse from our pacemaker-initiated ventricular beat to penetrate the atrial-nodal circuit. In this example we have a PPI of 541, minus a TCL of 360 – well above the 110, and far away from the tachycardia circuit. When we paced from the ventricle we were entraining the tachycardia, but we were pacing from a point in the conduction system far away from the tachycardia initiation point.We also used a few other techniques to help our diagnosis: we did incrementally faster pacing from the ventricle, and also from the atrium, and we saw that the conduction from the atrium to the ventricle, and the conduction from the ventricle to the atrium, as we increased the speed, was decremental; both the AV delay AND the VA delay grew longer. This indicates that the patient is unlikely to have an accessory pathway – in an accessory pathway the conduction is not decremental as it’s the AV node that slows down the conduction from the atria to the ventricle and vice-versa. There are some other pathways which could be considered, and we’ll discuss these another time.This is a great example of getting some really sophisticated EPS and making a clear diagnosis using already-implanted dual chamber devices. We followed this with a typical AVNRT ablation which ended up being a really simple procedure based on the information we already had from her pacemaker.It’s uncommon, in our experience, to use already-implanted devices to perform fully diagnostic EP studies. Does your department use this method? If you have any experience or comments about this, if you have any thoughts about the benefits or limits of these methods, we’d love to hear from you!Here at EPme.me we love feedback; our aim is to help you learn so please do get in touch with ideas for sessions you’d like to see. Whether you work in electrophysiology, devices, both or neither, we want to hear from you. Follow our YouTube channel to keep up to date with leading cardiac electrophysiology from around the world. Sign up for our newsletter to receive our free ECG cheatsheet — you’ll wonder how you did without it.COMING UP: Next few weeks, we’re gonna be talking some great EP cases’ Fresh from the EP lab Part 1 - “4th time lucky”. Some really interesting case studies from the EP lab.Thank you so much!Website: https://epme.me/Instagram: http://instagram.com/cardiac_electrophysiologyTwitter: https://twitter.com/EPmedotmeFacebook: https://www.facebook.com/EPme.me/Pinterest: https://www.pinterest.com/epmedotme/YouTube channel:https://www.youtube.com/channel/UCism4RgECx2HYcn4x_IWhbA?sub_confirmation=1

Syncope, or fainting, is an incredibly common complaint seen by #EMS providers. This short episode discusses some of the exam findings and considerations. The Epsilon wave: https://litfl.com/epsilon-wave-ecg-library/ Wolff Parkinson White syndrome: https://www.youtube.com/watch?v=K098rnvqRE0 Lown Ganong Levine syndrome: https://ecglibrary.com/lgl.html

Dr. Berberian joins EMRA*Cast with Alex Kaminsky to delve deeper into the pathophysiology and electrical findings associated with diagnoses such as WPW, Brugada and ARVD in part 1 of this series. Lumps and Bumps: Can’t-Miss Diagnoses in Syncope (Part 1) Host: Alex Kaminsky Guest: Jeremy Berberian, MD Associate Director of Resident Education: Christiana Health System Editor-in-chief: EMRA EKG Guide Author EM Resident Monthly ECG Challenge. Overview: Residents are well programmed to recognize cardiovascular emergencies such as STEMIs at a glance. However, during a busy shift it can be easy to overlook dysrhythmias and other electrophysiologic urgencies and emergencies. Syncope is a prime example of a chief complaint that may be uncovered with an EKG alone -- however syncopal emergencies are often subtle and nuanced. Dr. Berberian joins EMRA*Cast with Alex Kaminsky to delve deeper into the pathophysiology and electrical findings associated with diagnoses such as WPW, Brugada and ARVD in part 1 of this series. Key Points: Wolff-Parkinson-White (WPW) Prevalence: 0.7 to 1.7 per 10000 Overview: Accessory Pathway Connecting the atria to the ventricle. In some instances, this can cause the accessory pathway to travel FASTER than through the AV node. Orthodromic (Narrow): Travels down the AV node (can bypass) Antidromic (Wide): Bypasses AV node and UP the his-purkinje system.   Courtesy of CardioNetworks: Free use image Key Features:  Image: Courtesy of EMRA EKG Guide Short PR (less than 120ms) “Delta” wave -- which is a “slurring” of the QRS complex QRS might be “a little” wide (still 2mm with a negatively deflected T in right precordial leads (V1-V3) Potentially diagnostic as isolated EKG finding. Type 2: ST elevation in right precordial leads (V1-V3) with a “saddleback.” Within the STE.   Not completely diagnostic but concerning fr workup.   Clinical Criteria (EKG Findings PLUS one or more): SYNCOPE Nocturnal Agonal Respirations Brugada gets WORSE with parasympathetic stimuli. Family member with known Type 1 Observed/Documented VT/VF Sudden cardiac death in family member 55ms (in 95% of patients) Slightly prolonged QRS >110ms (Right precordial leads) VT looks more like a Left-bundle morphology -- Appreciate that AFTER the patient is out of VT.   Key Resources: *If needed and/or different than references* EMRA EKG Guide Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Syncope: Huff J.S., Decker W.W., Quinn J.V., Perron A.D., Napoli A.M., Peeters S., Jagoda A.S.( 2007)  Annals of Emergency Medicine,  49 (4) , pp. 431-444. Epidemiological profile of Wolff-Parkinson-White syndrome in a general population younger than 50 years of age in an era of radiofrequency catheter ablation. Lu C.-W., Wu M.-H., Chen H.-C., Kao F.-Y., Huang S.-K. (2014)  International Journal of Cardiology,  174  (3) , pp. 530-534. Reference, G. (2019). Brugada syndrome. [online] Genetics Home Reference. Available at: https://ghr.nlm.nih.gov/condition/brugada-syndrome#statistics [Accessed 14 Feb. 2019]. McNally E, MacLeod H, Dellefave-Castillo L. Arrhythmogenic Right Ventricular Cardiomyopathy. 2005 Apr 18 [Updated 2017 May 25]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1131/

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnoses or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello. Welcome to "Cancer Stories." I'm Dr. Daniel Hayes, a medical oncologist, and translational researcher at the University of Michigan Rogel Cancer Center, and I've also been the past president of ASCO. I'll be your host for a series of interviews with the founders of our field. Over the last 40 years, I've been fortunate to have been trained, mentored, and inspired by many of these pioneers. It's my hope that through these conversations we can all be equally inspired, by gaining an appreciation of the courage, the vision, and the scientific understanding that led these men and women to establish the field of clinical cancer care over the last 70 years. By understanding how we got to the present and what we now consider normal in oncology, we can also imagine and work together towards a better future, where we offer patients better treatments and we're also able to support them and their families during and after cancer treatment. Today, My guest on this broadcast is Dr. Samuel Hellman, who is generally considered one of the fathers of modern radiation oncology in the United States and frankly, worldwide. Dr. Hellman is currently a professor emeritus at the University of Chicago Pritzker Medical School, where he served as the dean from 1988 to 1993. And he's been the A.N. Pritzker Professor of the Division of Biological Sciences. He's also served as the vice president of the University of Chicago Medical Center. Prior to moving to Chicago in the late 1980s, he had previously been physician in chief and the professor of radiation oncology at the Memorial Sloan Kettering Cancer Center. He served there from 1983 to 1988, and he was also chair of the Department of Radiation Therapy at the Harvard Medical School, where he served as the co-founding director of the Joint Center for Radiation Therapy. Dr. Hellman has authored over 250 peer-reviewed papers, and he's been one of the co-editors of one of the leading textbooks on oncology, Cancer, Principles and Practice. Dr. Hellman has won many awards and honors, including being named a fellow of the National Academy of Medicine, formerly the Institute of Medicine, and of the American Association for the Advancement of Science. He is frankly, one of the few individuals to serve as president of both the American Association of Cancer Research and the American Society of Clinical Oncology, for which he was actually, I believe-- correct me if I'm wrong Dr. Hellman-- the first radiation oncologist to hold that position, which he served in 1986 to 1987. Dr. Hellman, welcome to our program. Thank you for having me. I hope I got all that right. Your introduction has taken longer than some of the others. You have been so prominent in the field. I have a series of questions. The whole point of this is sort of like Jerry Seinfeld's Riding in a Cab with Friends. I've always said, if I had an opportunity to right with some of the giants in our field, what would I ask them during a cab ride? So I get to ask the questions, and you get to answer. I know you grew up in the Bronx. Can you tell us a little bit more about your background? I'm particularly intrigued about the fact that a boy from the Bronx ended up at Allegheny College in Pennsylvania. Why'd you go there? What was your interest? Was it always in science and medicine, or did you have something else in mind? OK. Well, start with the Bronx. I was born in 1934 in the Bronx in a nice part of the city, which doesn't often go with descriptions of the Bronx today, but it was at that time. And about well, 1950, which was when I entered my senior year in high school, I had gone to high school at DeWitt Clinton High School. And as I say, my senior year, we moved to Long Island, and I spent my senior year at Lawrence High School. The important part of this is that Clinton had about 4,500 to 5,000 boys, and Lawrence High School was much smaller and most importantly, coeducational, and that made me very much want to go to a smaller school for college and definitely one that was coeducational. And so my mother and I took a little tour of colleges not too far from New York, but Allegheny was the farthest, I think. It's in Western Pennsylvania, very close to the Ohio border. And it was a beautiful day. I had a very nice two people showing me around, and I became enamored of the place. It was a very good fit for me, but I must say, my method was not a very analytic one, but that's how I got to Allegheny College. And was science and medicine in your thoughts then, or did you have other things that you thought you'd do? No, no. I was a middle-class Jewish boy from the Bronx. You're programmed to be interested in medicine. The old comment was, you know what a smart boy who can't stand the sight of blood becomes? The answer is a lawyer. And I was not offended by the sight of blood. So I actually heard about your decision to go to SUNY Upstate Syracuse and the serendipity involved. And I'm always struck by how so many of us have what we plan and what we end up doing. Can you give us that story? I though it was really fascinating. Well, I'm not sure what part of it you want, but I went to Syracuse Upstate because I won a state scholarship, and I hadn't applied to any New York state schools. And fortunately, the medical school advisor and a former Alleghenian, who was at Upstate, arranged an expedited interview, et cetera. So anyway, that's why I ended there. Why I ended up in radiation oncology-- Well, that was my next question is, how did we get lucky that you decided to go into oncology? Well, I interned at Boston at the Beth Israel Hospital, which was essentially very oriented to cardiovascular disease. Our chairman was a renowned cardiologist. He was the first one to use radioactive tracers. He used radium, as it turned out, and there is an award given by the nuclear medicine society. Their big award, their annual award is the Hermann Blumgart Award, and Blumgart was my chairman. And Paul Zoll, the external defibrillator inventor, was there. Louis Wolff of Wolff-Parkinson-White syndrome was there. So it was a cardiac place. And internal medicine was what I wanted to do, but my father was quite hard of hearing and had a lot of trouble making a living, because he was so impaired. And electronic devices, of course, weren't available at that time. And it was widely thought that otosclerosis which is what he had, was a hereditary disease. And so I was discouraged somewhat from entering medicine, not being able to be sure I could use a stethoscope. Parenthetically, I have never had any trouble, and the disease is no longer thought to be hereditary but rather the sequelae of infectious diseases, either diphtheria or influenza. This was the great influenza epidemic. The two, one of those two. But anyway, that's what he had, so I sought to do something else. And I was a little bit put off by taking care of disease which we really could not alter the course of. We could modify it. We could palliate, but probably if I were more dexterous, I would have become a surgeon. But I wasn't, and so I decided I didn't know what to do. I'd take a radiology residency and see where that led. This was late in the year, and there were no radiology residences, literally, in Boston that were available. But a new chief had come to Yale, and he was starting a new program. And one of radiologists in a neighboring institute told me go there. So I did. Well, he turned out to be a radiation oncologist, and he, Morton Kligerman and Henry Kaplan, were the two chairmen of departments of radiology who were radiation oncologists. And Henry had been at the NIH and got them to, with the National Cancer Institute, I guess, to start a fellowship program to encourage radiation oncology. And Kligerman applied for one, got one. I was there. I was captivated by the opportunity to do some curative treatment. I was a chemistry major in college, and physics and chemistry were things I enjoyed. Sounded like a good choice, so that's what happened. So there could not have been very many specific radiation oncology fellowship programs at that time in the United States. Is that true? Yeah, very much true. The ones that stood out was, I say, Henry Kaplan's. There was a very good one at UCSF. And there was one in Penrose Cancer Hospital and one at the MD Anderson, and those were the ones. So your decision to go oncology then, really your decision to go into radiology-- diagnostic radiology originally, sorry-- didn't sound like you were-- Not really. I took a radiology residency, because I thought it would be helpful whatever I decided to do. I really didn't expect to go into diagnostic radiology, but I figured that's something I could do. I didn't have much training or any training in that before. There was a great dynamic radiologist at the Beth Israel Hospital, and he captivated me. And so I figured, there's a lot to learn there, and I'll try it. I think a lot of the younger doctors don't realize that the two were together for a long time. What's your perspective of the split between diagnostic and therapeutic radiology-- I've actually heard you talk about this, so I think I know what you're going to say-- and bringing them back together? Well, I was a great proponent of it. The whole fields are entirely different. But having diagnostic radiology is extremely helpful in radiation oncology, because we depend on images to determine how we treat, where we treat, and so forth, so it was there. But they were interested in entirely different things. And just parenthetically, when I took the Harvard job, I wasn't going to take it unless I had a promise that we could start a Department of Radiation Oncology. Shortly after I came, and the decision was made with just a shake of the hand that, after a year or two, I'd be able to do that, and that's what happened. Actually, that segues into another question I had is I was looking over your background. I met you first when I was a first-year fellow at the medical oncology. That was 1982, by the way, a long time ago, when it was still the Sidney Farber. And I'd heard about your legendary efforts starting the Joint Center and also your teaching methods with your own residencies. But you were rubbing shoulders with Sidney Farber and Francis "Franny" Moore and Tom Frei. That must have been pretty intimidating for a relatively young guy trying to start a whole new department. What was the impetus behind that? It was an interesting experience. Dr. Farber was, of course, the dominant figure in cancer at Harvard, and nationally, he was one of, if not the great leader. I mean, but he was a difficult man, and I don't like to speak disparaging, but we had a rocky relationship. When the Joint Center-- I'm getting ahead of my story, but it's appropriate to this question. When the Joint Center was started, it was started by Harvard Medical School, and the dean for hospital affairs was a man named Sidney Lee. Dr. Lee had formerly been the head of the Beth Israel Hospital, the director, not the chairman of medicine but the director. And he got the idea that all the hospitals in the Harvard area were relatively small, the Mass General was across town and quite large, but that was not true for the Brigham or the BI or the Deaconess or what at that time was the Boston Hospital for Women. And so he got them all together. So there were those, and I think I left out the Children's, but Children's was amongst them, as well as the Sidney Farber, as you say. Or at that time, it wasn't called that. It was called the Jimmy Fund, but that's another story, and one you know better than I, I suspect. But anyway, those six were to get together when I started the Joint Center. Because Dr. Farber and I had so much difficulty with each other-- he wanted really for me to be reporting to him and being part of the Jimmy Fund but that wouldn't have worked with the other hospitals. He was not liked by any of the places, including Children's, which is where he was the pathologist. So those six initial institutions, when we finally came to sign, turned out to be only four because the Children's wouldn't come in, and the Jimmy Fund wouldn't come in. For a number of reasons, two years later, they acquiesced, mostly because we were successful, and they were without supervoltage treatment, and it was just not sensible for them not to join. But that's my relationship with Sidney. Franny Moore is a different story. Franny Moore was an internationally-known surgeon and expected to have his way, but he was very graceful, very nice. I had very few disagreements with him. He expected, and I think, deserved certain deferences. Sydney did, too, but it just made it too difficult to do that but Franny was not that way. Franny and I came to the treatment, conservative treatment of breast cancer from different points of view. He didn't agree with it, but he was entitled to his opinion, and he was fine. Tom is a different story. I got there ahead of Tom, and he came, and if anything, I helped out Tom, although he was much senior. Harvard has its own culture, as you know, and he needed at least an introduction. I mean, he sailed along fine after that. And in fact, at one time, he and I wanted to start a joint residency program. It was to be a four-year program, which would have people take two years together and two years in their respective specialty. But the boards were not in agreement, so it was dropped. But Tom and I always got along fine. Actually, that raises one of my other questions. I spent a lot of time in Europe, and the field of so-called clinical oncology still remains, combining radiation and medical oncology. In fact, they style it as a particular specialty in Great Britain. How did it evolve not that way in the United States? Radiation oncology went off on its own. And I think you had a lot to do with really professionalizing radiation oncology as a specialty in this country. Is that not true? I'd be interested in your perspectives on this, too. Well, I should parenthetically say that I spent a year in the National Health Service in 1965, while I was a fellow at Yale, in clinical oncology at the Royal Marsden Hospital, their major teaching hospital for cancer. And I always believed in the joint efforts of a non-surgical oncology program. You can include the surgeons, mostly because their lives are so different and their technical training is much more extensive, but you can work closely with them, and I've been fortunate to be able to do that. But medical oncology and radiation, in my judgment, would be better off close together. And your comment about me and ASCO, being the first president as a radiation oncologist, and I never call myself a radiation oncologist, at least not initially. I always call myself an oncologist. But I do, I agree and then describe what I do as radiation. But I agree with you, they have the best title-- clinical oncologists. And why it occurred the way it occurred, I'm not sure. I know we started in radiology and medical oncology started in hematology. I mean, the real revolution, and leaving aside Dave Karnofsky and his work, the real changes occurred in acute leukemia. And the real founders of the specialty, Dave was surely one of them, but a great many of them were all hematologists, leukemia doctors, and it grew from there. It grew out of hematology. And a lot of major oncology papers were in Blood, the journal Blood before they were in JCO. So that's the best I can do with it. Our big thing was to separate from diagnostic. Getting closer to medical oncology is much easier, because we have the same book. You said I wrote the textbook with Vince and Steve, and so I did. And that was very easy. We spoke the same languages. We saw the same things, not completely. I saw more head and neck. Vince saw more of the hematologic malignancies, but the rules were similar. It was no-- it was easy. And I've heard Dr. Frei-- I trained with him when he was alive and obviously, Dr. DeVita talked about what it was like to give chemotherapy when they started. And how we really professionalized, in many ways, and split up giving chemotherapy, the different responsibilities. What was it like with radiation oncology back 40 years ago? I mean, how did you-- the safety issues, were you all cognizant of the safety issues related to radiation at the time? How did you do your planning? What was that like? Well, safety was-- Hiroshima made everybody know a lot. In fact, if anything, we were more conservative than we probably needed to be because of radioactivity being an evil and all the things that happened after '45 and at Hiroshima and Nagasaki experience. And so safety wasn't a problem that way. But there were a lot of people in the field who were using the field, who are not radiation oncologists. Some of them were radiologists, diagnostic radiologists and did it part time. They had a cobalt unit, before that, just an orthovoltage, conventional energy, much less effective and more damaging. And also gynecologists, and when I visited Memorial Hospital early on in my training, and the surgeons would send a prescription blank, a regular prescription dying down to the radiation therapist. And that's what they were, technicians, or often were. And they may have differed with the prescription but only by being careful and discussing it with the surgeons and convincing them that some change should be. That's very different. How was the planning done? How was the planning done? The planning was fairly primitive. Well, most places had a physicist, usually a physicist, who did both diagnostic machines and conventional radiation oncology, and they were important in that department and those people subspecialized, too. And in fact, when I came to Boston in 1968, Herb Abrams, who was the new chairman of radiology-- he's the one who chaired the committee that selected me-- but he and I jointly started a physics department. So it was still in diagnosis as well as therapy, but we realized that wasn't a good idea and separated. So physics was evolving, but treatment planning before supervoltage, and even with supervoltage before multileaf collimators and a lot of the newer, what then were newer techniques, was reasonably rudimentary. When I did my residency, we did our own planning, and usually, it got checked by the physicist but not all the time. It's a lot different now. Yes, it is. I want to turn this to an area that's more personal to me and that is your role, out of all the many contributions you've made to the field, your role in the field of breast-preserving therapy. I came in just as you and Jay Harris were really making that institutionalized. Just for our listeners, what were the hurdles there? They must have been both personal and professional and technical. And did you ever doubt that this be successful in the long run? You must have had some second thoughts about getting into this. Well, I have to back up. It was well before Jay, but it was at Yale. And apropos of how many-- going back to our previous question-- how few radiation oncologists there were. There was a club. Before there was a specialty, before there was a society, there was the American Club of Radiation Therapy. And all you had to do to belong to it was do radiation therapy without doing diagnostic radiology. And I was in the low 200ths of the consecutive order of people who belonged to the specialty from its very inception at the turn of the century. So there were very few of us, and we knew each other extremely well and had these little conversing meetings. And a number of people would talk about patients who had medical diseases which wouldn't allow them to have their breasts removed. They still had localized, apparently localized breast cancer, and the radiation therapist took care of them, and I did, too. I had these people. And we also had the Europeans, especially the French, who were treating breast cancer with radiation. In fact, they were doing it with a fundamental difference with what we did from the beginning and they do now. And that is, they did it without removing the breast cancer, because they were doing it primarily for cosmetic reasons. And they felt that taking out the breast cancer might damage the cosmetic effect. So we weren't alone. We weren't first. So I knew that other people had done it. Some people who did, Simon Kramer in Pennsylvania at Jefferson, Thomas Jefferson, did a great deal of it. And we did it, because we had a surgeon at Yale who was interested in sending patients. You mentioned Jay, but really, before Jay, there was Lenny Prosnitz, who you may or may not know of, who was a long-time chairman at Duke. But Len was a medical oncologist at Yale, who was about, I don't know, three or four years behind me in training, and I was either a young assistant professor there at the time or a fellow, I can't remember which. And he came over to me and said, you've got a nice life. You do interesting things. I'm not so crazy with this. Can I get into it? And Lenny, obviously, being trained in medical oncology, being a boarded internist was also interested in breast cancer. Because that's the one disease, even in the beginning that medicine, or one of the few diseases that medicine was interested in for the hormonal aspects of the disease. So Lenny took over when I left with the surgeon Ira Goldenberg, and he kept it up. And when I went to Harvard, I had all those different hospitals, and I had a very good colleague there, who was the only radiation oncologist in those hospital complex, and he also treated some. So we continued to do it. One of the nice things about Harvard at that time was, at least for this purpose, was we had this women's hospital, Boston Hospital for Women. And gynecologists in those days did everything for women and that included breast surgery. And those guys delivered their babies and when they got breast cancer, took care of them. They weren't interventional. They were their private primary care docs, and they were much more sensitive to the cosmetic aspects and the self-image aspects of breast cancer surgery. And so they knew we did it, and they became a big source of suggesting patients and sending them to us. Anyway, Marty, Marty Levine, the fellow I was talking about, and I developed a reasonable number of them. One of my residents, Eric Weber said, why don't you write a paper about this? I said, it's all done. The French have it. The Brits have it. Even the Canadians have it. He said, we don't. So I said all right. We sent out the paper, and the first paper is with Eric and Marty and me, and it was a JAMA paper and that gets to another point. What year was that? I had to bully pulpit. What year was that, the JAMA paper? The JAMA paper? About '75-- '74, '75. And it made a big splash. And then Lenny and Simon Kramer and Luther Brady, two Philadelphia people who had big experience, and us put all of our stuff together. And Lenny brought it all together, and so there was another big paper. I think that one was in JCO, but maybe not. I can't remember. And I think that's how it got started. And my issue with it and my involvement in it is, yes, pioneering the treatment in America. I don't claim to have pioneered it anywhere else. It wouldn't be true. But what I did do is use the bully pulpit of being the Harvard professor, and I went everywhere and talked about it. And I took on the surgeons in a number of places and talked about it. And if I made a contribution to it, it was that. I can remember being in an audience and hearing you talk about the Halstead theory and then the Fisher theory and what became known, in my opinion, as the Hellman theory, which is a combination of the two. That both local and systemic therapies make a difference, and the mortality rate of breast cancer has dropped by almost one-half over the last 30 years, and you should be proud of that. Oh, I'm proud of it. I'm proud of it. But people don't do things in a vacuum. You build on people and on their doings. Well, I want to be respectful of your time, if I can finish up here. I really just touched the surface of many of the contributions you've made. I wanted to talk a little bit about your role in getting radiation oncologists to think about what we now call translational science. But at the end here, what do you think are your greatest accomplishments? What do you think your legacy has been to the field? Do you think it's the science or your administration or your teaching and mentoring or all of those together? I think all of us would like to think about what our legacies would be. Oh, I would say, it's an interesting and not an easy question, because I'm interested in all of those things. But I like to remind people that, and it's been commented on by others, I am one of the few people who maintained a practice of medicine, a real practice, all through being a dean. I always think of myself first as a doctor. And I am an investigator, and I am interested in research, both basic and clinical, and did both of them, but I'm a doctor first, that's number one. Second to that, I was very involved in teaching and believe-- and that's why I became a dean and before that, started a department in Harvard and gave courses in oncology, and my residents are my greatest legacy, if you really want to know. Nobody lives forever, and what you did in the lab and your patients, that passes, but your residents are your history. They continue it, and their residents continue it and so forth. And just to end on a high note that you mention, is that the Karnofsky lecturer this year was one of my residents. Yes, he was. Of course, that's Ralph Weichselbaum. He was. I actually chaired the selection committee, and I can't tell you how proud I was to stand up and introduce him. He did a wonderful job. In addition to your own residents, I'm going to tell you, you're also passing this on to the medical oncology fellows who were hanging around the Farber in those days. And to this day, I tell patients I wear two hats. My first hat is to take care of them as I can with the knowledge I have today, and my second hat is to do research to make it better. But my first hat always wins, because Dr. Hellman said you're a doctor first. So there you go. Well, I haven't changed on it. That's very nice to hear though. OK. I think on that note, we'll end up. I had planned over about half an hour. We're just over that. So thank you very much, both from me, personally, and from those of us in the field and from our patients who have benefited. Dr. Hellman, you are truly a pioneer and a giant in our field. So thank you so much. Well, you're very kind to say so. For more original research, editorials, and review articles, please visit us online at jco.org. This production is copyrighted to the American Society of Clinical Oncology. Thank you for listening.

This week on Sickboy we sit down with Will MacGregor; a man whos braved the medical system, run the gauntlet of tests and treatments, and has advocated for himself to receive the care he needs. His mysterious and fascinating story involves a diagnosis of Wolf Parkinson White Syndrome that has lead to a series of unfortunate complications that we explore in this in-depth chat. With Taylor away in sunny Nicaragua, the guys invited special guest host, Andrew The Camera Guy, to help reign things in. Evidently, by the length of this conversation, he did a shit job at keeping things on track… or perhaps this was just a case of a long rollercoaster-of-a-story detailing Will’s battle with WPW and it’s associated complications! After listening to this episode you’ll pretty much be a doctor, so hold on tight, take some notes, and get ready to learn a shit load!

This week on Sickboy we sit down with Will MacGregor; a man whos braved the medical system, run the gauntlet of tests and treatments, and has advocated for himself to receive the care he needs. His mysterious and fascinating story involves a diagnosis of Wolf Parkinson White Syndrome that has lead to a series of unfortunate complications that we explore in this in-depth chat. With Taylor away in sunny Nicaragua, the guys invited special guest host, Andrew The Camera Guy, to help reign things in. Evidently, by the length of this conversation, he did a shit job at keeping things on track… or perhaps this was just a case of a long rollercoaster-of-a-story detailing Will’s battle with WPW and it’s associated complications! After listening to this episode you’ll pretty much be a doctor, so hold on tight, take some notes, and get ready to learn a shit load!

This week on Sickboy we sit down with Will MacGregor; a man whos braved the medical system, run the gauntlet of tests and treatments, and has advocated for himself to receive the care he needs. His mysterious and fascinating story involves a diagnosis of Wolf Parkinson White Syndrome that has lead to a series of unfortunate complications that we explore in this in-depth chat. With Taylor away in sunny Nicaragua, the guys invited special guest host, Andrew The Camera Guy, to help reign things in. Evidently, by the length of this conversation, he did a shit job at keeping things on track… or perhaps this was just a case of a long rollercoaster-of-a-story detailing Will’s battle with WPW and it’s associated complications! After listening to this episode you’ll pretty much be a doctor, so hold on tight, take some notes, and get ready to learn a shit load! 

大家好，欢迎收听报姐说腐国。之前报妹跟大家分享了很多关于英国的各种奇闻趣事，涨了不少知识。在新的一季里，报妹会给大家介绍一些来自全球各地的、各行各业的顶级人物。有神秘高贵的皇室，也有万众瞩目的歌星。希望大家会喜欢。在上一期的《歌手》节目里，英国女歌手Jessie J结石姐，以一首《Domino》技惊四座，一开口就slay。被誉为“教科书级的表演”的同时，也轻松收获了第一期冠军。宽广的音域，稳健的台风，游刃有余的演唱，网友都说：结石姐都出场了，不比了不比了…还有的说，感觉自己看了一场演唱会，有点缓不过来。不少观众的评价都是：一个能打的都没有说到结石姐，她的歌曲，几乎首首大火。许多国内的朋友对她本人并不是很了解，但只要一听歌，肯定就知道旋律。从那首唱着“money moneymoney”的《Price Tag》和麻辣鸡、A妹合作的《Bang Bang》再到励志经典《Who You Are》2014年，结石姐、麻辣鸡、A妹三人在AMA颁奖礼现场表演的《BangBang》，结石姐的实力，真的是掀翻全场。不过，很多人不知道，拥有绝对实力和传唱度的同时，结石姐其实患有心脏疾病，甚至曾因此取消巡演，暂时隐退休养。一边是疾病，一边是天籁之音，她从来没有停下追逐音乐的脚步。今天，报妹就来说说，结石姐到底是何方神圣。1988年出生的结石姐，原名JessicaEllen Cornish，艺名Jessie J。中国歌迷们叫她结石姐，是根据英文音译过来的。从小，结石姐就展现出了过人的歌唱天赋，11岁在伦敦西区的歌舞剧登台，15岁拿到了电视歌唱冠军，16岁进入全英数一数二的艺术表演学校BRIT School。BRIT School培养了大批顶尖的音乐人才，除了结石姐，还有和她同一届毕业，也是我们熟知的英国歌手阿黛尔Adele。与生俱来的天赋，加上顶尖的音乐教育，科班出身的结石姐，会唱歌会谱曲会写词，所向披靡。她，为音乐而生。2006年，结石姐从学校毕业，正式踏上了职业歌手之路。但那看上去顺风顺水的音乐道路，却一直困难重重。从出生开始，结石姐就在与自己的先天性心脏问题作斗争。因为家族性的遗传，她患上了一种名为Wolff-Parkinson-White syndrome预激综合症的心脏疾病。简单的说，这种疾病是心脏房室传导的异常现象，容易引起心率过速，是一种少见的心率失常病症。而结石姐的演唱风格，大多有激昂澎湃飙高音的旋律，需要配合大量的呼吸和体力，这对想成为职业歌手的结石姐来说，无疑是巨大的打击。从小，她就不停地在医院进出。结石姐2012年的自传中回忆道：“小时候，我经常莫名其妙的昏倒，有时候还会有癫痫发作。可能上一秒我还好好的，下一秒我就不省人事了。”青春期时，结石姐的症状也并没有缓解，甚至愈演愈烈。17岁时，因为长期的音乐练习和繁忙的演唱日程，结石姐竟然在一次表演之后经历了中风，倒在了后台。也许是经历过生死考验，结石姐创作和演唱的歌曲，都特别洒脱励志。她说：“小时候我体弱多病，经常被同学欺负，是疾病让我坚强，它造就了今天的我。”她把对周围的观察和人生的感悟，一一写进了自己的歌里。抨击拜金，就写首《Price Tag标价签》，感叹人们都给自己标榜身价，买卖交易，穿着虚伪的高跟鞋，活的不痛快。质疑自己的时候，就写首《Nobody's Perfect没人是完美的》，自我反思，直指自己的缺点和优点，告诉大家没人是完美的。疾病带来的痛苦，非但没有让她倒下，反而激励了她唱歌的斗志。正式出道7年至今，结石姐已经在全球卖了2000多万张专辑。表演的场合从伦敦奥运会开闭幕仪式，到海德公园十万人的场子，什么大风大浪都见识过。结石姐说，就算是生病，开不了巡演了，但每一次演唱，她都唱live，绝对不假唱。结石姐对音乐的赤诚，实在令人佩服。结石姐的这份洒脱和真实，在生活中也处处体现，她就是一个大写的耿直girl。成名前，结石姐在纽约的地铁站里，简陋的条件下，唱了自己歌曲的《Who You Are你是谁》。没有任何华丽的配乐和修饰，她在人来人往中认真地唱着“不要迷失自我，不必逞强，要做真实的自己”。出道以来，她更是不遗余力做慈善。在一次慈善的节目拍摄时，她二话没说答应了主持人的要求，现场让对方把自己她最具代表性的发型Bobo头剃光，用来募集善款。“不就剃个头吗？反正头发会长长的，无所谓了！”不仅如此，她还曾邀请患了绝症的小粉丝上台，和自己合唱，为对方打气。也参加过各式各样的公益义演，为生病的孩子谋福利。这次来中国，结石姐在长沙逛街，听到店里放她的歌曲时，带着周围的粉丝一起唱歌互动，一点巨星的架子都没有。而回到舞台上，结石姐又变成了那个敢疯敢唱，充分享受舞台的歌手。炫技飙高音，或是用花哨的舞台当噱头，都不是最震撼人心的演唱。结石姐真正最打动人的，恰恰是经过她的真诚和自信过滤之后的，天籁之音。从体弱多病的音乐少女，到震惊乐坛的巨嗓天后，结石姐用她的音乐感动了许多人。不少乐评人说，第一场比赛，结石姐只发挥了六七成的功力，如果火力全开，可能真的会掀翻屋顶。让我们一起拭目以待。

大家好，欢迎收听报姐说腐国。之前报妹跟大家分享了很多关于英国的各种奇闻趣事，涨了不少知识。在新的一季里，报妹会给大家介绍一些来自全球各地的、各行各业的顶级人物。有神秘高贵的皇室，也有万众瞩目的歌星。希望大家会喜欢。在上一期的《歌手》节目里，英国女歌手Jessie J结石姐，以一首《Domino》技惊四座，一开口就slay。被誉为“教科书级的表演”的同时，也轻松收获了第一期冠军。宽广的音域，稳健的台风，游刃有余的演唱，网友都说：结石姐都出场了，不比了不比了…还有的说，感觉自己看了一场演唱会，有点缓不过来。不少观众的评价都是：一个能打的都没有说到结石姐，她的歌曲，几乎首首大火。许多国内的朋友对她本人并不是很了解，但只要一听歌，肯定就知道旋律。从那首唱着“money moneymoney”的《Price Tag》和麻辣鸡、A妹合作的《Bang Bang》再到励志经典《Who You Are》2014年，结石姐、麻辣鸡、A妹三人在AMA颁奖礼现场表演的《BangBang》，结石姐的实力，真的是掀翻全场。不过，很多人不知道，拥有绝对实力和传唱度的同时，结石姐其实患有心脏疾病，甚至曾因此取消巡演，暂时隐退休养。一边是疾病，一边是天籁之音，她从来没有停下追逐音乐的脚步。今天，报妹就来说说，结石姐到底是何方神圣。1988年出生的结石姐，原名JessicaEllen Cornish，艺名Jessie J。中国歌迷们叫她结石姐，是根据英文音译过来的。从小，结石姐就展现出了过人的歌唱天赋，11岁在伦敦西区的歌舞剧登台，15岁拿到了电视歌唱冠军，16岁进入全英数一数二的艺术表演学校BRIT School。BRIT School培养了大批顶尖的音乐人才，除了结石姐，还有和她同一届毕业，也是我们熟知的英国歌手阿黛尔Adele。与生俱来的天赋，加上顶尖的音乐教育，科班出身的结石姐，会唱歌会谱曲会写词，所向披靡。她，为音乐而生。2006年，结石姐从学校毕业，正式踏上了职业歌手之路。但那看上去顺风顺水的音乐道路，却一直困难重重。从出生开始，结石姐就在与自己的先天性心脏问题作斗争。因为家族性的遗传，她患上了一种名为Wolff-Parkinson-White syndrome预激综合症的心脏疾病。简单的说，这种疾病是心脏房室传导的异常现象，容易引起心率过速，是一种少见的心率失常病症。而结石姐的演唱风格，大多有激昂澎湃飙高音的旋律，需要配合大量的呼吸和体力，这对想成为职业歌手的结石姐来说，无疑是巨大的打击。从小，她就不停地在医院进出。结石姐2012年的自传中回忆道：“小时候，我经常莫名其妙的昏倒，有时候还会有癫痫发作。可能上一秒我还好好的，下一秒我就不省人事了。”青春期时，结石姐的症状也并没有缓解，甚至愈演愈烈。17岁时，因为长期的音乐练习和繁忙的演唱日程，结石姐竟然在一次表演之后经历了中风，倒在了后台。也许是经历过生死考验，结石姐创作和演唱的歌曲，都特别洒脱励志。她说：“小时候我体弱多病，经常被同学欺负，是疾病让我坚强，它造就了今天的我。”她把对周围的观察和人生的感悟，一一写进了自己的歌里。抨击拜金，就写首《Price Tag标价签》，感叹人们都给自己标榜身价，买卖交易，穿着虚伪的高跟鞋，活的不痛快。质疑自己的时候，就写首《Nobody's Perfect没人是完美的》，自我反思，直指自己的缺点和优点，告诉大家没人是完美的。疾病带来的痛苦，非但没有让她倒下，反而激励了她唱歌的斗志。正式出道7年至今，结石姐已经在全球卖了2000多万张专辑。表演的场合从伦敦奥运会开闭幕仪式，到海德公园十万人的场子，什么大风大浪都见识过。结石姐说，就算是生病，开不了巡演了，但每一次演唱，她都唱live，绝对不假唱。结石姐对音乐的赤诚，实在令人佩服。结石姐的这份洒脱和真实，在生活中也处处体现，她就是一个大写的耿直girl。成名前，结石姐在纽约的地铁站里，简陋的条件下，唱了自己歌曲的《Who You Are你是谁》。没有任何华丽的配乐和修饰，她在人来人往中认真地唱着“不要迷失自我，不必逞强，要做真实的自己”。出道以来，她更是不遗余力做慈善。在一次慈善的节目拍摄时，她二话没说答应了主持人的要求，现场让对方把自己她最具代表性的发型Bobo头剃光，用来募集善款。“不就剃个头吗？反正头发会长长的，无所谓了！”不仅如此，她还曾邀请患了绝症的小粉丝上台，和自己合唱，为对方打气。也参加过各式各样的公益义演，为生病的孩子谋福利。这次来中国，结石姐在长沙逛街，听到店里放她的歌曲时，带着周围的粉丝一起唱歌互动，一点巨星的架子都没有。而回到舞台上，结石姐又变成了那个敢疯敢唱，充分享受舞台的歌手。炫技飙高音，或是用花哨的舞台当噱头，都不是最震撼人心的演唱。结石姐真正最打动人的，恰恰是经过她的真诚和自信过滤之后的，天籁之音。从体弱多病的音乐少女，到震惊乐坛的巨嗓天后，结石姐用她的音乐感动了许多人。不少乐评人说，第一场比赛，结石姐只发挥了六七成的功力，如果火力全开，可能真的会掀翻屋顶。让我们一起拭目以待。

SRJ Episode 2, Volume 1(1) by Siebert and Rao

In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation.

In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. The post Episode 20: Atrial Fibrillation appeared first on Emergency Medicine Cases.

As a bonus to Episode 20 on Atrial Fibrillation, we present here, Dr. Clare Atzema, a leading EM researcher in Atrial Fibrillation, telling her Best Case Ever related to Afib. What would you do if you needed to cardiovert a patient who was too obese to fit on an ED stretcher? Dr. Atzema, along with Dr. Nazanin Meshkat and Dr. Bryan Au, discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate vs rhythm control are debated, what you need to know about Afib medications, and the value of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use anticogulants or ASA for stroke prevention for patients with Afib. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. [wpfilebase tag=file id=382 tpl=emc-play /] [wpfilebase tag=file id=383 tpl=emc-mp3 /]

As a bonus to Episode 20 on Atrial Fibrillation, we present here, Dr. Clare Atzema, a leading EM researcher in Atrial Fibrillation, telling her Best Case Ever related to Afib. What would you do if you needed to cardiovert a patient who was too obese to fit on an ED stretcher? Dr. Atzema, along with Dr. Nazanin Meshkat and Dr. Bryan Au, discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate vs rhythm control are debated, what you need to know about Afib medications, and the value of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use anticogulants or ASA for stroke prevention for patients with Afib. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. [wpfilebase tag=file id=382 tpl=emc-play /] [wpfilebase tag=file id=383 tpl=emc-mp3 /] The post Best Case Ever 7: Atrial Fibrillation appeared first on Emergency Medicine Cases.