Sat.Sep 09, 2023 - Fri.Sep 15, 2023

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Blood pressure should be measured lying down: study

American Heart News - Stroke News

American Heart Association Hypertension Scientific Sessions – Abstract 452. An analysis of data from a long-running study of more than 11,000 adults from four diverse communities in the United States has found that adults who had high blood pressure while both seated upright and lying supine (flat on their backs) had a higher risk of heart disease, stroke, heart failure or premature death compared to adults without high blood pressure while upright and supine.

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A 60-year-old diabetic with chest pain, cath lab activated

Dr. Smith's ECG Blog

I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" I said, "Cool, can I see the ECG?' Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." So he showed me the ECG recorded in triage: What did I say? "That is not a STEMI. That is Arterial Pulse Tapping Artifact (APTA)." He said: "What?

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ECG Cases 45 ECG in Weakness and Neurological Symptoms

ECG Cases

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV th

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ECG Blog #395 — No Simple Explanation.

Ken Grauer, MD

The tracing in Figure-1 was sent to me for my interpretation. As per the title of today's Blog post — There is no simple explanation for all that is happening in this challenging tracing. Are YOU up for the challenge? I found that the most challenging part of today's tracing is determining the etiology of beat "X". As I explain below — I think it unlikely that beat "X" represents a single, slightly accelerated junctional beat.

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8 Benefits Of Minimally Invasive Cardiac Surgery

MIBHS

Cardiovascular disease remains a leading cause of mortality worldwide. In fact, The American Heart Association (AHA) reports that approximately 82.6 million people in the United States currently have one or more forms of cardiovascular disease (CVD). Due to the prevalence of cardiovascular disease, there are continuous advancements in cardiac surgery techniques.

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Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Dr. Smith's ECG Blog

Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. He reported a normal stress test a few years ago.

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EM Quick Hits 51 – Methylene Blue in Septic Shock, TMJ Dislocation, Crohn’s Disease, Analgesia for Renal Colic, Inhaled Steroids for Asthma, Hypocalcemia in Bleeding Trauma Patients

ECG Cases

On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients.

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Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease

Open Heart

Objectives Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events.

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A 40 year old with nonspecific symptoms including dizziness

Dr. Smith's ECG Blog

A 40 year old with nonspecific symptoms including dizziness. What do you notice about the ECG? There is a very short QT interval. This is often found in hypercalcemia. See Ken Grauer's comments below for detail. Thus, the patient's chemistry was done and revealed ionized hypercalcemia of 6.3 mg/dL (normal 4.4 - 5.2) Followup: he was found to have hyperparathyroidism == MY Comment , by K EN G RAUER, MD ( 9/12 /2023 ): == Today's ECG is remarkable for an uncommon but important finding that we peri

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Call for papers! Thematic Collection on Cardiac Amyloidosis

International Journal of Cardiovascular Sciences

The International Journal of Cardiovascular Sciences is pleased to invite Brazilian and international researchers to submit articles for the thematic collection on cardiac amyloidosis , which will have Dr. Marcos Vinícius Simões as responsible editor and will be published in 2024 Cardiac amyloidosis is a rare and serious disease that results from the accumulation of amyloid proteins in the heart.

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Future Lp(a) Treatment Options

Dr. Paddy Barrett

An elevated Lp(a) is the most common genetic cholesterol disorder impacting 10-20% of the population. It is easily tested for with a simple blood test, but unfortunately, this is rarely done. Everyone should have an Lp(a) blood test at least once, but this is an absolutely must-do test if you have an early family history of heart disease. Subscribe now The defect is not actually with the cholesterol transported in the lipoprotein particle but with alterations to a protein tail and its configurat

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AVNRT TYPICAL FORM

ECG Guru

18-year-old male; palpitations lasting hours, beginning at the age of 10. What arrhythmia is present? Let's first consider the heart rate: with a heart rate of 194 beats/min, the heart rate is too low for atrial flutter (1:1) (except in patients who have been pre-treated with medication), and the rate would be unusually high for atrial flutter with 2:1 conduction.

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Best Cardiology Practice Management Software

GEMMS

Efficiently managing a cardiology practice presents many unique challenges that demand effective solutions. From delivering exceptional patient care and precise diagnostics to managing complex billing and administrative tasks, the importance of efficient systems cannot be overstated. This is where specialized cardiology practice management software steps in, serving as a crucial tool to ensure streamlined operations and exceptional patient care.

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Mitral Valve Intervention Training: Key Takeaways from Our recently held Training

ADN Center of Excellence

ADN CoE recently held an exceptional two-day training focused on the latest techniques for treating mitral valve disease. Led by Assoc. Prof. Ismail Ateş and Dr. Zeynettin Kaya; renowned experts in mitral valve interventions, this course offered an amazing opportunity for continued education. The training provided clinicians with a deeper understanding of mitral valve anatomy, function, and disease processes.

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Inferior vena cava diameter and risk of acute decompensated heart failure rehospitalisations

Open Heart

Objectives Inferior vena cava (IVC) diameter may be a surrogate for volume status in acute decompensated heart failure (ADHF). The utility of IVC diameter measurement is under studied. The aim of this study was to assess the relationship between IVC diameter, clinical variables and ADHF rehospitalisations. Methods Retrospective chart review of 200 patients admitted for ADHF from 2018 to 2019 with transthoracic echocardiogram during index hospitalisation.

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Polymorphic ventricular tachycardia during a stress EKG. What is the most likely cause?

ECG Guru

This EKG shows a sinus rhythm with ventricular bigeminy and retrograde conduction leading to retrograde depolarization of the sinus node, resulting in a longer pause (sinus node reset). Then, a polymorphic ventricular tachycardia occurs over 7 beats. The QT interval of the sinus beats does not appear prolonged, thus ruling out Torsades de Pointes tachycardia.

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Nine lessons about women’s heart disease that future doctors will learn in med school

Heart Sisters

These nine @CWHHA teaching modules offer a one-stop Master Class package to any academic tasked with teaching future doctors and nurses about women and heart disease.

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Comorbidities and clinical response to cardiac resynchronization therapy: patient?level meta?analysis from eight clinical trials

European Journal of Heart Failure

Aims Patients with heart failure usually have several other medical conditions that might alter the effects of interventions. We investigated whether the burden of comorbidity modified the clinical response to cardiac resynchronization therapy (CRT). Methods and results Original patient-level data from eight randomized trials exploring the effects of CRT versus no CRT were pooled (BLOCK-HF, MIRACLE, MIRACLE-ICD, MIRACLE-ICD II, RAFT, COMPANION, MADIT-CRT and REVERSE).

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Impact of heart rate, aortic compliance and stroke volume on the aortic regurgitation fraction studied in an ex vivo pig model

Open Heart

Introduction Drug therapy to reduce the regurgitation fraction (RF) of high-grade aortic regurgitation (AR) by increasing heart rate (HR) is generally recommended. However, chronic HR reduction in HFREF patients can significantly improve aortic compliance and thereby potentially decrease RF. To clarify these contrasts, we examined the influence of HR, aortic compliance and stroke volume (SV) on RF in an ex vivo porcine model of severe AR.

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Nonconducted PACs

ECG Guru

A common cause of pauses and bradycardia are non-conducted PACs, which generally do not require treatment. Therefore, it is important to differentiate between pauses or bradycardia that require treatment.

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Pitfalls in the diagnosis of arrhythmogenic right ventricular cardiomyopathy

HeartRhythm

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy resulting from disordered function of the intercalated discs with mainly arrhythmic manifestation, which can be difficult to diagnose because of its variable presentation. The incidence of ARVC is reported to be 1:2000 to 1:5000. The exact incidence is difficult to estimate because many patients remain undiagnosed or are misdiagnosed.

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Three-dimensional analysis of the tricuspid annular geometry in healthy subjects and in patients with different grades of functional tricuspid regurgitation

Cardiovascular Ultrasound

Accurate sizing of the tricuspid valve annulus is essential for determining the optimal timing of tricuspid valve (TV) intervention. Two-dimensional (2D) echocardiography has limitations for comprehensive TV a.

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Long?Term Stability of Patients Undergoing Endovascular Parent Artery Occlusion of Their Intracranial Artery

Stroke: Vascular and Interventional Neurology

Stroke: Vascular and Interventional Neurology, Volume 3, Issue 6 , November 1, 2023. BackgroundAlthough endovascular parent artery occlusion (PAO) of the intracranial artery is a well‐established treatment option, the long‐term stability of cerebral blood flow remains a concern. This study aimed to evaluate the long‐term clinical and radiological outcomes of patients who underwent PAO.MethodsThe patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between Ap

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Treatment and Control of Hypertension Among Adults With Chronic Kidney Disease, 2011 to 2019

Hypertension Journal

Hypertension, Volume 80, Issue 12 , Page 2533-2543, December 1, 2023. BACKGROUND:Hypertension frequently accompanies chronic kidney disease (CKD) as etiology and sequela. We examined contemporary trends in hypertension treatment and control in a national sample of adults with CKD.METHODS:We evaluated 5% cross-sectional samples of adults with CKD between 2011 and 2019 in the Veterans Health Administration.

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A Review On Lactic Acidosis In Cardiac Surgery

BMH Medical Journal

The normal range of lactate is 0-2mmol/L and value above it is considered as hyperlactatemia. It may arise due to adequate and non-adequate oxygen supply mechanisms. The major reason is likely stress –induced aerobic mechanism which shows raised results of lactate. Increased lactate levels can cause acidifying effects on the blood. There are many etiological reasons for lactic acidosis like disease condition, deficiency and alcohol.

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Socioeconomic status may be an uneven predictor of heart health

Science Daily - Heart Disease

The benefits of four measures of socioeconomic status (education, income, employment status and health insurance) on ideal heart health were greater for non-Hispanic white adults compared to Black, Hispanic and Asian adults in the U.S.

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Endovascular Treatment in Acute Basilar Artery Occlusion Stroke: A Brief Practice Update From the Society of Vascular and Interventional Neurology

Stroke: Vascular and Interventional Neurology

Stroke: Vascular and Interventional Neurology, Volume 3, Issue 6 , November 1, 2023. BackgroundThe Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee established the “Brief Practice Update” format to provide up‐to‐date recommendations on focused relevant clinical questions. In this Brief Practice Update, we review current evidence and provide recommendations for endovascular treatment (EVT) in patients with acute large‐vessel occlusion of the basilar art

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Obesity-Related Biomarkers Are Associated With Exercise Intolerance and HFpEF

Circulation: Heart Failure

Circulation: Heart Failure, Volume 16, Issue 11 , Page e010618, November 1, 2023. BACKGROUND:Obesity and adiposity are associated with an increased risk of heart failure with preserved ejection fraction (HFpEF); yet, specific underlying mechanisms remain unclear. We sought to examine the association of obesity-related biomarkers including adipokines (leptin, resistin, adiponectin), inflammatory markers (CRP [C-reactive protein], IL-6 [interleukin-6]), and insulin resistance (HOMA-IR) with HFpEF

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Cross talk: Fat and the arrhythmogenic substrate

HeartRhythm

The classical view that scarred, fibrotic myocardium in patients with myocardial infarction (MI) is the basis for ventricular tachycardia by producing a critical activation delay in surviving myocardial strands1 was recently challenged by Sung et al.2 They quantified the volume of epicardial adipose tissue in patients with MI in combination with a personalized computer simulation study and came to the conclusion that infiltrating adipose tissue is more predictive of the occurrence of ventricular

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CT test simulates blood flow to assess risk in patients with angina

Science Daily - Heart Disease

An advanced CT test can identify individuals with stable angina at a reduced risk of three-year adverse outcomes despite their having a high coronary artery calcium score, according to a new study.

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Nationwide Trends in Reperfusion Therapy and Outcomes of Acute Ischemic Stroke According to Severity: The Japan Stroke Data Bank

Stroke: Vascular and Interventional Neurology

Stroke: Vascular and Interventional Neurology, Volume 3, Issue 6 , November 1, 2023. BackgroundIt is unclear whether all patient subgroups with acute ischemic stroke have benefited from advances in reperfusion therapy. We investigated long‐term trends of reperfusion therapy and outcomes according to the stroke severity.MethodsPatients with acute ischemic stroke registered in the prospective nationwide hospital‐based registry between 2000 and 2020 were examined.

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Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair

Circulation: Heart Failure

Circulation: Heart Failure, Ahead of Print.

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Early repolarization in the left posterior leads of the electrocardiogram: A new challenge for the existence of idiopathic ventricular fibrillation

HeartRhythm

A few decades ago all sudden cardiac arrests with documented ventricular fibrillation (VF) and structurally normal hearts were diagnosed as idiopathic ventricular fibrillation (IVF). Recognition of distinct arrhythmia syndromes over the last 3 decades, such as long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and early repolarization (ER) syndrome (ERS), has changed this field, and the diagnosis of IVF has substantially decreased.1 In addition, identifica

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Researchers develop novel, automated measure of sleep studies to determine severity of obstructive sleep apnea

Science Daily - Heart Disease

New method can predict risks of cardiovascular disease, mortality in sleep apnea patients.

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Machine Learning–Enabled Detection of Unruptured Cerebral Aneurysms Improves Detection Rates and Clinical Care

Stroke: Vascular and Interventional Neurology

Stroke: Vascular and Interventional Neurology, Volume 3, Issue 6 , November 1, 2023. BackgroundUnruptured cerebral aneurysms (UCAs) have a relatively low prevalence of ≈3%, but detection can prevent devastating consequences of subarachnoid hemorrhage. Here, we assess the performance of a machine learning algorithm to identify UCAs and determine whether routine use of the algorithm improves detection and patient care.MethodsFrom a prospectively maintained multicenter registry across 8 certified s

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Natural History of Echocardiographic Changes in Atrial Fibrillation: A Case-Controlled Study of Longitudinal Remodeling

HeartRhythm

Atrial fibrillation (AF) can be a cause and consequence of cardiac remodeling. The natural history of remodeling associated with AF is incompletely described.