Sat.Nov 25, 2023 - Fri.Dec 01, 2023

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ECG Blog #405 — Is AV Block Complete (vs AV Dissociation)

Ken Grauer, MD

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. On the basis of this rhythm strip — she was diagnosed as being in complete AV Block.

Blog 176
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Lost brain function restored in mice after stroke

Science Daily - Stroke

Researchers have succeeded in restoring lost brain function in mouse models of stroke using small molecules that in the future could potentially be developed into a stroke recovery therapy.

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Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?

Dr. Smith's ECG Blog

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" What do you think? Here they are: Patient 1, ECG1: Zoll computer algorithm stated: " STEMI , Anterior Infarct" Patient 2, ECG1: Zoll computer algorithm stated: "ST elevation, probably benign early repolarization.

STEMI 119
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EM Quick Hits 53 Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM

ECG Cases

On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine immobilization controversies and techniques, Navpreet Sahsi on the difference between humanitarian and development work The post EM Quick Hits 53

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ECG Blog #406 — To Do Additional Leads?

Ken Grauer, MD

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier.

Blog 167
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Rude Awakening on Trying to Keep Donor Hearts Usable With Common Hormone Infusions

Med Page Today

(MedPage Today) -- Giving unstable brain-dead heart donors intravenous levothyroxine did not lead to more hearts being transplanted, a randomized trial showed. In hemodynamically unstable potential donors, administering the thyroid hormone supplement.

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Early Rhythm Control, Lifestyle Modification and More Tailored Stroke Risk Assessment Are Top Goals in Managing Atrial Fibrillation

American Heart News - Heart News

DALLAS and WASHINGTON (Nov. 30, 2023) — The American Heart Association (AHA) and the American College of Cardiology (ACC), along with several other leading medical associations, have issued a new guideline for preventing and optimally managing atrial.

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A Man of Many Modalities: Jeremy Long Celebrates 20 Years of Dedicated Service

Cassling

As Cassling continues to grow, we’re always evolving to better serve our customers. One way we’re doing this is by expanding our equipment service offerings. Expanded service is an ask that came from our customers, and it is a direct result of the trust and confidence they have in dedicated field service engineers like Jeremy Long.

Blog 97
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Physiology Friday #194: Exercise "Prehab" Prevents Muscle Loss during Inactivity

Physiologically Speaking

Greetings! Welcome to the Physiology Friday newsletter. This newsletter is brought to you by Examine.com — the best place on the internet for health and nutrition information — and my new eBook, “VO2 Max Essentials.” Details can be found at the end of the post! Physiologically Speaking is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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Coronary heart disease before age 45 may increase risk of dementia later in life

American Heart News - Heart News

Research Highlights: People diagnosed with coronary heart disease had a significantly increased risk of developing dementia later in life, according to an analysis of data for more than 430,000 people from the UK Biobank. Participants who had.

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Chest pain and new regional/reciprocal ECG changes compared to previous ECGs: code STEMI?

Dr. Smith's ECG Blog

Written by Jesse McLaren A 45 year old presented with two weeks of recurring non-exertional chest pain, now constant for an hour. Below is old and then new ECG (old on top; new below). What do you think? Both ECGs have normal sinus rhythm, normal conduction and normal voltages. There’s a change in axis that may interfere with direct lead-to-lead comparison, but there appear to be larger T waves in I/aVL and new TWI in III/aVF.

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VTE Risk After Joint Replacement: Does Anticoagulant Choice Matter?

Med Page Today

(MedPage Today) -- Among younger patients undergoing total hip or knee replacement, whether they received aspirin versus direct oral anticoagulants (DOACs) did not seem to affect their risk of venous thromboembolism (VTE) following surgery, a large.

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Comparing Efficacy and Safety Between Patients With Atrial Fibrillation Taking Direct Oral Anticoagulants or Warfarin After Direct Oral Anticoagulant Failure

Journal of the American Heart Association

Journal of the American Heart Association, Volume 12, Issue 23 , December 5, 2023. BackgroundAn increased risk of recurrent stroke is noted in patients with atrial fibrillation despite direct oral anticoagulant (DOAC) use. We investigated the efficacy and safety of treatment with each of 4 different DOACs or warfarin after DOAC failure.Methods and ResultsWe retrospectively analyzed patients with atrial fibrillation with ischemic stroke despite DOAC treatment between January 2002 and December 201

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Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction

JAMA Cardiology

This secondary analysis of a randomized clinical trial assesses whether myocardial viability testing identifies patients with ischemic left ventricular dysfunction who benefit from percutaneous coronary intervention.

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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Circulation

Circulation, Ahead of Print. AimThe “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.MethodsA comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Re

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'Alexa, Titrate My Insulin': AI App Boosts Glycemic Control in Randomized Trial

Med Page Today

(MedPage Today) -- A custom artificial intelligence (AI) app for insulin management advice helped patients with type 2 diabetes gain rapid glycemic control, a small randomized clinical trial found. In titrating basal insulin, those who used a.

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Resting Heart Rate Independent of Cardiovascular Disease Risk Factors Is Associated With End?Stage Renal Disease: A Cohort Study Based on 476?347 Adults

Journal of the American Heart Association

Journal of the American Heart Association, Volume 12, Issue 23 , December 5, 2023. BackgroundThe relationship between resting heart rate (RHR) and the risk of end‐stage renal disease (ESRD) among those without cardiovascular disease remains unclear. We aim to establish temporal consistency and elucidate the independent relationship between RHR and the risk of ESRD.Methods and ResultsThis cohort enrolled participants from 476 347 individuals who had taken part in a screening program from 1996 to

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Wearable Digital Health Technology

The New England Journal of Medicine

Wearable DHT has reached an inflection point between fanciful descriptions and practical applications. The editors announce a series of articles focusing on the clinical applications of wearable DHT.

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Intermittent Theta-Burst Stimulation for Stroke: Primary Motor Cortex Versus Cerebellar Stimulation: A Randomized Sham-Controlled Trial

Stroke Journal

Stroke, Ahead of Print. BACKGROUND:Stroke survivors with impaired balance and motor function tend to have relatively poor functional outcomes. The cerebellum and primary motor cortex (M1) have been suggested as targets for neuromodulation of balance and motor recovery after stroke. This study aimed to compare the efficacy and safety of intermittent theta-burst stimulation (iTBS) to the cerebellum or M1 on balance and motor recovery in patients with stroke.METHODS:In this randomized, double-blind

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Flipped C-Terminal Ends of apoA1 Promote ABCA1-Dependent Cholesterol Efflux by Small HDLs

Circulation

Circulation, Ahead of Print. BACKGROUND:Cholesterol efflux capacity (CEC) predicts cardiovascular disease independently of high-density lipoprotein (HDL) cholesterol levels. Isolated small HDL particles are potent promoters of macrophage CEC by the ABCA1 (ATP-binding cassette transporter A1) pathway, but the underlying mechanisms are unclear.METHODS:We used model system studies of reconstituted HDL and plasma from control and lecithin-cholesterol acyltransferase (LCAT)–deficient subjects to inve

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Rationale and design of the ESC Heart Failure III Registry – Implementation and discovery

European Journal of Heart Failure

ABSTRACT Aims Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline-recommended therapy in Europe and other ESC affiliated countries. Methods Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enro

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Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices

Journal of Cardiovascular Electrophysiology

Abstract Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management.

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Association Between Onset Age of Coronary Heart Disease and Incident Dementia: A Prospective Cohort Study

Journal of the American Heart Association

Journal of the American Heart Association, Volume 12, Issue 23 , December 5, 2023. BackgroundThe association of age at coronary heart disease (CHD) onset with incident dementia remains unexplored. This study aimed to examine whether younger onset age of CHD is associated with a higher risk of incident dementia.Methods and ResultsData were obtained from the UK Biobank.

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Concordance of a High Lipoprotein(a) Concentration Among Relatives

JAMA Cardiology

This cross-sectional study measures the association of lipoprotein(a) concentrations in pairs of first- and second-degree relatives of participants in the UK Biobank with high lipoprotein(a) levels.

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Dental Caries, Race and Incident Ischemic Stroke, Coronary Heart Disease, and Death

Stroke Journal

Stroke, Ahead of Print. BACKGROUND:Dental caries is a highly prevalent disease worldwide. In the United States, untreated dental caries is present in >1 in 5 adults. The objective of this study was to determine the relationship between dental caries and incident ischemic stroke, coronary heart disease (CHD) events, and death.METHODS:The dental cohort (n=6351) of the ARIC study (Atherosclerosis Risk in Communities) was followed for incident ischemic stroke, CHD event, and all-cause mortali

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Headset identifies 78% of strokes prior to hospital arrival: Study

Becker's Hospital Review - Cardiology

Sacramento, Calif.-based Sutter Health has taken part in testing and researching a headset designed to help emergency technicians better identify large vessel occlusion ischemic strokes prior to patients arriving at the hospital.

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Excess Bed Days and Hospitalization Costs Associated With 30?Day Complications Following Catheter Ablation of Atrial Fibrillation

Journal of the American Heart Association

Journal of the American Heart Association, Volume 12, Issue 23 , December 5, 2023. BackgroundThe incidence and type of complications following catheter ablation of atrial fibrillation have been extensively examined, but the impact associated with these complications on the length of stay and hospitalization costs is unknown.Methods and ResultsThis cohort study included 20 117 adult patients (mean age 62.6±11.4 years, 30.3% women, median length of stay 1 day [interquartile range 1–2 days]) underg

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Intravenous Levothyroxine for Unstable Brain-Dead Heart Donors

The New England Journal of Medicine

In this randomized trial involving hemodynamically unstable brain-dead potential heart donors, intravenous levothyroxine infusion did not result in more hearts being transplanted than saline infusion.

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First multi-chamber heart organoids unravel human heart development and disease

Science Daily - Heart Disease

Heart disease kills 18 million people each year, but the development of new therapies faces a bottleneck: no physiological model of the entire human heart exists -- so far. A new multi-chamber organoid that mirrors the heart's intricate structure enables scientists to advance screening platforms for drug development, toxicology studies, and understanding heart development.

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Cerebral Small Vessel Disease, Hypertension, and Vascular Contributions to Cognitive Impairment and Dementia: Dementia Series

Hypertension Journal

Hypertension, Ahead of Print. Hypertension-associated cerebral small vessel disease is a common finding in older people. Strongly associated with age and hypertension, small vessel disease is found at autopsy in over 50% of people aged ≥65 years, with a spectrum of clinical manifestations. It is the main cause of lacunar stroke and a major source of vascular contributions to cognitive impairment and dementia.

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Endovascular Brain-Computer Interfaces in Poststroke Paralysis

Stroke Journal

Stroke, Ahead of Print. Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions.

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Constrictive Pericarditis

The New England Journal of Medicine

A 69-year-old woman with a history of focal pleural plaques due to occupational asbestos exposure presented with chronic dyspnea on exertion. Chest imaging showed calcification of the pericardium.

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Coronary heart disease before age 45 may increase risk of dementia later in life

Science Daily - Heart Disease

Having coronary heart disease at a younger age was associated with an increased risk of dementia, Alzheimer's disease and vascular dementia, finds a new study.

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Do You Need A Stent To Treat Your Heart Disease?

Dr. Paddy Barrett

One of the most common questions I get is, “ Do I need a stent to treat my heart disease?” Typically, several of this person’s friends have had stents, so it seems natural to ask. First, we must understand what a stent is and why it is used. Subscribe now A stent is a metal scaffold deployed in a coronary artery that has reduced flow in that artery to restore flow.

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Physiology Friday #194: Exercise "Prehab" Prevents Muscle Loss during Inactivity

Physiologically Speaking

Greetings! Welcome to the Physiology Friday newsletter. This newsletter is brought to you by Examine.com — the best place on the internet for health and nutrition information — and my new eBook, “VO2 Max Essentials.” Details can be found at the end of the post! Physiologically Speaking is a reader-supported publication.

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Can you try these two questions on Amyloid ?

Dr. S. Venkatesan MD

Is it a physiological molecule ? 1.Yes, It is a physiological molecule. 2.No, Amyloid is always pathological. Where does it gets deposited ? A.Extracellular* B. Intracellular C. Both Answer : Q 1: A / Q 2: C. It is indeed a physiological molecule in small amounts that help carry hormones across the blood. In pathology, it accumulates in huge amounts.

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How Mental Health Can Affect Your Heart Health

MIBHS

The intricate connection between mental health and physical well-being has been a subject of growing interest in recent years. While it’s well-known that mental health issues like anxiety and depression can profoundly impact one’s quality of life, what’s often overlooked is their potential to affect physical health, particularly the heart.