MedWorm Tags: cardiovascular

More on the differential diagnosis of wide complex tachycardia

Notes from Dr. RW — Fri, 02 Sep 2011 11:36:00 +0100

(Source: Notes from Dr. RW)

Systematic review of therapeutic hypothermia after resuscitation from cardiac arrest

Notes from Dr. RW — Wed, 31 Aug 2011 12:06:00 +0100

(Source: Notes from Dr. RW)

Concise update on hypertrophic cardiomyopathy

Notes from Dr. RW — Wed, 31 Aug 2011 12:02:00 +0100

(Source: Notes from Dr. RW)

STEMI or early repolarization?

Notes from Dr. RW — Tue, 30 Aug 2011 11:57:00 +0100

(Source: Notes from Dr. RW)

Causes of death in patients hospitalized with pneumonia

Notes from Dr. RW — Tue, 30 Aug 2011 11:55:00 +0100

(Source: Notes from Dr. RW)

The Bloodmobile

The A and P Student — Mon, 29 Aug 2011 02:12:00 +0100

Sometimes catchy little songs can help us learn even very complex concepts.My friend Ellen recently sent along this video with the snappy tune Bloodmobile. This song from They Might Be Giants summarizes the main functions of the blood . . . a very timely topic for those of you at the beginning of your A&P 2 course.While we're on a cardiovascular theme, you may recall seeing my previous post Pump Your Blood that features the classic song of the same name that has been used by countless A&P students to learn the path of blood through the heart.Have any more? Why not share them? (Source: The A and P Student)

Wiggle waves, small spike waves and smooth potential waves: variations in epsilon waves and other ECG criteria for right ventricular cardiomyopathy

Notes from Dr. RW — Thu, 25 Aug 2011 10:53:00 +0100

(Source: Notes from Dr. RW)

Tutorials in the Tetons 2011---ACLS update

Notes from Dr. RW — Wed, 24 Aug 2011 22:49:00 +0100

(Source: Notes from Dr. RW)

Tutorials in the Tetons 2011---what's new in the epidemiology of atrial fibrillation?

Notes from Dr. RW — Wed, 24 Aug 2011 02:56:00 +0100

(Source: Notes from Dr. RW)

Tutorials in the Tetons 2011---noninvasive cardiovascular imaging

Notes from Dr. RW — Wed, 24 Aug 2011 00:30:00 +0100

(Source: Notes from Dr. RW)

In the young patient with DVT

Notes from Dr. RW — Fri, 19 Aug 2011 13:23:00 +0100

(Source: Notes from Dr. RW)

Management of cardiac arrest in pregnancy

Notes from Dr. RW — Wed, 17 Aug 2011 14:57:00 +0100

(Source: Notes from Dr. RW)

Point of care echo to evaluate for pericardial tampanade

Notes from Dr. RW — Wed, 17 Aug 2011 14:55:00 +0100

(Source: Notes from Dr. RW)

FDA Approves GE’s Newest CT Scanner

Better Health — Mon, 15 Aug 2011 21:05:47 +0100

GE Healthcare has received the FDA OK for its Optima CT660 computed tomography (CT) system. The CT660, which is already available in Europe, Latin America and Asia, distinguishes itself by its compact footprint combined with a modular design and low dose imaging. In addition, it is also one of the most energy efficient CT scanners available and has an “environmental design” that eases refurbishment and end-of-life recycling. The scanner itself is scalable from 32 to 128 slices through purchasable options and features automatic table positioning and a color 12-inch integrated gantry display monitor. (more…) *This blog post was originally published at Medgadget* (Source: Better Health)

Reaching Out to Carers Innovation Fund

Fade Library — Mon, 15 Aug 2011 07:43:52 +0100

Scan or click to download 'Reaching Out to Carers Innovation Fund' The Title: Reaching Out to Carers Innovation Fund The Skinny: The Reaching Out to Carers Innovation Fund, is a scheme specifically targeted at voluntary sector organisations in England who, in addition to their primary work with individuals with particular conditions, illnesses or from particular age groups or communities, are also keen to support carers. [download id="17"] provides a list of dunded projects. 79 projects will be funded at a total value of £1.35m. These projects will: focus on early contact with those who are taking on a caring role for the first time, through different settings, e.g. hospitals, GP surgeries, the workplace, supermarkets, places of worship and other community settings, and help th...

Chronic HT in pregnancy

Notes from Dr. RW — Tue, 09 Aug 2011 16:33:00 +0100

(Source: Notes from Dr. RW)

A Diet Enriched With Olive Oil Is Associated With A Lower Stroke Risk In One Age Group

Better Health — Fri, 05 Aug 2011 18:00:00 +0100

More on the Mediterranean diet shows that olive oil is the key component associated with less stroke risk in seniors, a French study found. The Mediterranean diet has already been linked to better cardiovascular effects, so researchers poured it on to assess its link to stroke. A study of people 65 and older in the French cities of Bordeaux, Dijon and Montpellier divided 7,625 residents into three categories of olive oil consumption: no use, moderate use for cooking or dressing, or intensive use for both cooking and dressing. Researchers used plasma oleic acid as an indirect biological marker of oleic acid intake from olive oil. (They acknowledged that it could also stem from use of butter and goose or duck fat.) Results appeared in the Aug. 2 issue of Neurology. In the study, (more…...

Differential diagnosis of wide complex tachycardia

Notes from Dr. RW — Wed, 03 Aug 2011 12:00:00 +0100

(Source: Notes from Dr. RW)

Cardiovascular Problems? Stay Out Of The Heat

Better Health — Fri, 29 Jul 2011 16:00:46 +0100

The brutal heat wave gripping much of the country this week is unpleasant for healthy folks. For people with cardiovascular trouble, hazy, hot, humid days can be downright dangerous. Your body shouldn’t get too hot (or too cold). If your temperature rises too far, the proteins that build your body and run virtually all of its chemical processes can stop working. The human body sheds extra heat in two ways, both of which stress the heart: Radiation. Like water flowing downhill, heat naturally moves from warm areas to cooler ones. As long as the air around you is cooler than your body, you radiate heat to the air. But this transfer stops when the air temperature approaches body temperature. Radiation requires rerouting blood flow so more of it goes to the skin. This makes the heart beat fa...

Clot Connect MD

Notes from Dr. RW — Thu, 28 Jul 2011 10:52:00 +0100

(Source: Notes from Dr. RW)

Dealing with bleeding in patients on Pradaxa

Notes from Dr. RW — Thu, 28 Jul 2011 09:27:00 +0100

(Source: Notes from Dr. RW)

The anticoagulation forum

Notes from Dr. RW — Wed, 27 Jul 2011 20:48:00 +0100

(Source: Notes from Dr. RW)

Clinical Trial Costs Are Rising Rapidly

Pharmalot — Tue, 26 Jul 2011 14:39:41 +0100

As drugmakers scramble to replenish their pipelines, they are encountering all sorts of difficulties, including rising costs for clinical trials. And this is happening across all phases. Why? There is increasing competition for trial sites and clinical research organizations that can yield reliable, high quality data, according to a recent survey. And so, 32 percent of those surveyed pointed to higher costs for enrolling patients and 25 percent cited vendor fees. Expenses for recruiting trial sites was named by 14 percent, followed by 12 percent who fingered technology costs, according to Cutting Edge Information, which surveyed 21 drugmakers, 12 biotechs, nine device makers and 23 contract research organizations. Meanwhile, staffing for drug development is rising. For instance, Phase IV ...

CT angiography is not the diagnostic modality of choice for PE

Notes from Dr. RW — Tue, 26 Jul 2011 11:57:00 +0100

(Source: Notes from Dr. RW)

Review of therapeutic hypothermia after cardiac arrest

Notes from Dr. RW — Tue, 26 Jul 2011 11:19:00 +0100

(Source: Notes from Dr. RW)

Trends in elective PCI post-COURAGE

Notes from Dr. RW — Mon, 25 Jul 2011 17:59:00 +0100

(Source: Notes from Dr. RW)

Unexplained AV block in younger patients: think beyond the pacemaker!

Notes from Dr. RW — Mon, 25 Jul 2011 17:31:00 +0100

(Source: Notes from Dr. RW)

Benign versus malignant early repolarization---can they be distinguished?

Notes from Dr. RW — Mon, 25 Jul 2011 10:40:00 +0100

(Source: Notes from Dr. RW)

Do You Know What Metabolic Syndrome Is?

Better Health — Sun, 24 Jul 2011 12:00:10 +0100

People with metabolic syndrome are twice as likely to develop heart disease, and five times as likely to develop diabetes, as those who don’t have metabolic syndrome. But many people are not yet familiar with this relatively new term. Do you know what metabolic syndrome is? OECD Country Populations with a BMI > 30 (1996-2003) Metabolic syndrome is the combination of several medical problems associated with morbid obesity. In addition to obesity, these conditions include: (more…) *This blog post was originally published at Columbia University Department of Surgery Blog* (Source: Better Health)

A Few More Victories Like This, And We Will Be Undone

In the Pipeline — Fri, 22 Jul 2011 16:47:03 +0100

AstraZeneca has a lot of problems these days, so you'd think that approval of their new anticoagulant Brilinta would be reason for the company to celebrate. Not much, though - see this post at InVivoBlog for more. A lot of companies have piled into this space over the last ten years, seeking some of those huge, huge Plavix-style revenues. But blood thinning is a tricky business. One step over the line and you're causing more problems than you're helping. And given the heterogeneity of the patient population, you never quite know where that line is going to be. By this point, too, any new therapy is going to have to compete with the generic of tried-and tested Plavix pretty soon. No, anticoagulants of all sorts don't seem to making anyone as rich as they were supposed to. King Pyrrhus woul...

CT pulmonary angiography and overdiagnosis of PE

Notes from Dr. RW — Fri, 22 Jul 2011 15:31:00 +0100

(Source: Notes from Dr. RW)

FDA & EMA Review Heart Risks Of Sanofi’s Multaq

Pharmalot — Fri, 22 Jul 2011 12:27:27 +0100

Less than a month after Sanofi discontinued a Phase IIIb trial in patients who were treated with its Multaq heart med due to a significant increase in cardiovascular events, regulators on both sides of the pond now say they are reviewing the merits of the controversial drug. Ironically, the study found a two-fold increase in death, and two-fold increases in stroke and hospitalization for heart failure. The med is approved to reduce the risk of cardiovascular hospitalization in patients with persistent atrial fibrillation or atrial flutter who have had a recent episode and associated cardiovascular risk factors (here is the label). But the study was looking at people who suffer from permanent atrial fibrillation (see here). And so the study, called PALLAS, is now raising questions about th...

Brugada pattern quick reference card

Notes from Dr. RW — Wed, 13 Jul 2011 11:50:00 +0100

(Source: Notes from Dr. RW)

ACLS and the use of antiarrhythmic agents

Notes from Dr. RW — Wed, 13 Jul 2011 11:48:00 +0100

(Source: Notes from Dr. RW)

Post thrombotic syndrome

Notes from Dr. RW — Wed, 13 Jul 2011 11:34:00 +0100

(Source: Notes from Dr. RW)

Anticoagulation after VTE---indefinite or time limited?

Notes from Dr. RW — Wed, 13 Jul 2011 10:51:00 +0100

(Source: Notes from Dr. RW)

Diagnosis and treatment of VTE in pregnancy

Notes from Dr. RW — Tue, 12 Jul 2011 14:26:00 +0100

(Source: Notes from Dr. RW)

What's the appropriate cancer work up for patients presenting with unprovoked VTE?

Notes from Dr. RW — Tue, 12 Jul 2011 13:46:00 +0100

(Source: Notes from Dr. RW)

VTE in cancer patients

Notes from Dr. RW — Tue, 12 Jul 2011 11:22:00 +0100

(Source: Notes from Dr. RW)

Pocket mobile echocardiography---ready for prime time?

Notes from Dr. RW — Mon, 11 Jul 2011 13:01:00 +0100

(Source: Notes from Dr. RW)

Nesiritide---debate settled?

Notes from Dr. RW — Mon, 11 Jul 2011 10:27:00 +0100

(Source: Notes from Dr. RW)

Serum potassium levels after cardiac arrest

Notes from Dr. RW — Fri, 01 Jul 2011 10:35:00 +0100

(Source: Notes from Dr. RW)

BNP and proBNP testing in heart failure

Notes from Dr. RW — Mon, 20 Jun 2011 10:25:00 +0100

(Source: Notes from Dr. RW)

Ambulance diversion and acute MI mortality

Notes from Dr. RW — Thu, 16 Jun 2011 17:50:00 +0100

(Source: Notes from Dr. RW)

Up In Smoke: Pfizer’s Chantix Raises Heart Risk

Pharmalot — Thu, 16 Jun 2011 15:57:21 +0100

Yet another problem for Pfizer and its controversial smoking-cessation drug. The FDA has just decided to add a warning on the product labeling about an association with a small, but increased risk of cardiovascular adverse events in patients with cardiovascular disease. These are people who, of course, should not be smoking, but they are now being told the drug may be off limits. In reaching its decision, the FDA reviewed a study in which 700 patients with cardiovascular disease received either Chantix or placebo, and the results showed the Pfizer drug was effective in helping them quit smoking and remain abstinent for up to year. But Chantix was also linked more frequently to “certain events, including heart attack” (here is the statement and data summary). This is only the l...

Acute anterior STEMI with hyperacute T waves

Notes from Dr. RW — Tue, 14 Jun 2011 17:15:00 +0100

(Source: Notes from Dr. RW)

Sleep apnea and the involuntary siesta

Notes from Dr. RW — Fri, 10 Jun 2011 19:29:00 +0100

(Source: Notes from Dr. RW)

Cardiac Hope and Cardiac Hype

In the Pipeline — Thu, 09 Jun 2011 15:26:41 +0100

There have been quite a few headlines over the last few days like this one: "A New Drug Makes Hearts Repair Themselves". Unfortunately, that's not quite true. Not yet. It's this paper in Nature that's getting the attention, and it is a very interesting one. The authors have identified a population of progenitor cells in the adult heart that can be induced to turn into fully differentiated myocytes after an infarction. In fewer syllables, and reasonably accurately: stem cells, already in the heart, can be made to repair it after a heart attack. And that's getting closer to that headline I was just complaining about - so what's the gap between the two? Well, there are several rather huge factors. One of them is that the way that these cells were stimulated into action was by treatment with...

Extensive infarction, subtle ECG changes

Notes from Dr. RW — Tue, 31 May 2011 17:50:00 +0100

(Source: Notes from Dr. RW)

Niacin's Unexpected Flop

In the Pipeline — Fri, 27 May 2011 16:01:22 +0100

Let's add to the uncertainty about whether we understand cardiovascular disease, OK? The NIH has been conducting a large statin-plus-niacin trial, which is definitely a combination worth looking at. The statin will lower your LDL, and niacin will raise your HDL and lower your triglycerides (albeit with some irritating side effects). An earlier trial of niacin versus Zetia (ezetimibe) made the former look pretty good (and Zetia look pretty bad) using an endpoint of arterial examination by ultrasound. But now the NIH trial has been stopped, a full 18 months early. Not only did the addition of niacin show no benefit at all, but that treatment group actually had a slightly higher rate of ischemic stroke. This despite the combination working as planned, from a blood-marker standpoint. No, we r...

A clinical risk score for aortic dissection

Notes from Dr. RW — Thu, 26 May 2011 22:01:00 +0100

(Source: Notes from Dr. RW)

Abbott Cholesterol Pill Fails To Protect The Heart

Pharmalot — Thu, 26 May 2011 16:07:59 +0100

A study run by the National Institutes of Health was ended 18 months early after finding that adding Niaspan to a statin in people with heart disease did not reduce the risk of cardiovascular events, including heart attacks and strokes. Moreover, Niaspan may have boosted the risk of ischemic events, raising questions about the benefit of raising HDL, or so-called good cholesterol, to fight heart disease. The 3,414-person study, which added the Abbott Laboratories pill to Merck’s Zocor, found the combination was linked to stroke in 1.6 percent of patients, compared with 0.7 percent among those given a placebo. The combo failed to reduce heart attacks, heart-related hospitalizations and the need for procedures to reduce chest pain and restore strong blood flow to the heart. “The...

Comparative effectiveness research in action: dalteparin vs UFH in prevention of VTE

Notes from Dr. RW — Tue, 24 May 2011 22:44:00 +0100

(Source: Notes from Dr. RW)

What are the triggers for rupture of brain aneurysms?

Notes from Dr. RW — Wed, 18 May 2011 22:49:00 +0100

(Source: Notes from Dr. RW)

Fenofibrate: Good For Much?

In the Pipeline — Wed, 18 May 2011 17:37:00 +0100

Abbott has some difficult times ahead with their fenofibrate franchise. That's TriCor, and its newer formulation, TriLipix. Fenofibrate, as I've mentioned here before, is an oddity among drugs. It was discovered way before anyone had a mechanism of action, and even now, while it's supposed to be a PPAR-alpha ligand, no one's completely happy with that explanation. (For one thing, it's not very potent at that nuclear receptor, while other PPAR-alpha compounds have crashed in clinical trials for various reasons). But it can lower triglycerides and raise HDL, which should both (in theory) be beneficial effects, and it's been a big seller over the years. But how much good does it do? That's always the big, important, slow question in the cardiovascular field. The data for fenofibrate have alw...

More on NSAIDs and cardiovascular risk

Notes from Dr. RW — Mon, 16 May 2011 10:48:00 +0100

(Source: Notes from Dr. RW)

Patient centered conversations about ICDs

Notes from Dr. RW — Thu, 05 May 2011 10:54:00 +0100

(Source: Notes from Dr. RW)

Postural orthostatic tachycardia syndrome (POTs)

Notes from Dr. RW — Wed, 04 May 2011 12:56:00 +0100

(Source: Notes from Dr. RW)

The use of D-dimer and the Wells score improved utilization of CTA to diagnose PE

Notes from Dr. RW — Tue, 03 May 2011 10:43:00 +0100

(Source: Notes from Dr. RW)

Beer Bellies Anyone? Waist Measurement Can Determine Risk For Heart Disease

Better Health — Sat, 30 Apr 2011 12:00:10 +0100

Extra fat that accumulates around the abdomen goes by many names: beer belly, spare tire, love handles, apple shape, middle-age spread, and the more technical “abdominal obesity.” No matter what the name, it is the shape of risk. Abdominal obesity increases the risk of heart attack, stroke, diabetes, erectile dysfunction, and other woes. The danger zone is a waist size above 40 inches for men and 35 inches for women. As I describe in the April 2011 issue of the Harvard Men’s Health Watch, beer is not specifically responsible for a beer belly. What, then, is to blame? Calories. Take in more calories with food and drink than you burn up with exercise, and you’ll store the excess energy in fat cells. Many studies indicate that people who store their extra fat around the midsection (ap...

New guidelines for management of carotid and vertebral artery disease

Notes from Dr. RW — Fri, 22 Apr 2011 10:22:00 +0100

(Source: Notes from Dr. RW)

Risks vs benefits of statins

Notes from Dr. RW — Thu, 14 Apr 2011 10:42:00 +0100

(Source: Notes from Dr. RW)

Atherosclerotic Plaque Forms In Short Period

FuturePundit — Sat, 09 Apr 2011 23:00:00 +0100

Plaques that cause strokes and heart attacks form in just several years. In a new study performed in humans, researchers from Karolinska Institutet have determined the age of atherosclerotic plaques by taking advantage of Carbon-14 (14C) residues in the atmosphere, prevailing after the extensive atomic bomb tests in the 50ties and 60ties. The findings, published in the scientific online journal PLoS ONE, suggest that in most people plaque formation occurs during a relatively short and late time period in life of 3-5 years. This raises an obvious question: Why isn't plaque accumulation a long term process? What changes in the cardiovascular system that allows or causes a sudden acceleration in plaque formation? Do stem cells become too old to do... (Source: FuturePundit)

Warfarin over Pradaxa: CMS says it's a matter of “quality”

Notes from Dr. RW — Mon, 04 Apr 2011 21:20:00 +0100

(Source: Notes from Dr. RW)

Ways to increase your physical activity

Notes from Dr. RW — Mon, 04 Apr 2011 17:25:00 +0100

(Source: Notes from Dr. RW)

Vitamin D, the heart and cancer

Notes from Dr. RW — Tue, 29 Mar 2011 12:20:00 +0100

(Source: Notes from Dr. RW)

Do government payers follow the latest guidelines?

Notes from Dr. RW — Mon, 21 Mar 2011 17:37:00 +0100

(Source: Notes from Dr. RW)

The atherogenic lipid phenotype (ALP)

Notes from Dr. RW — Thu, 17 Mar 2011 12:39:00 +0100

(Source: Notes from Dr. RW)

Obesity Beats Adiposity For Cardiovascular Risk

Better Health — Wed, 16 Mar 2011 17:00:00 +0100

Obesity contributes to cardiovascular risk no matter where a person carries the weight, concluded researchers after looking at outcomes for nearly a quarter-million people worldwide. Body mass index, (BMI) waist circumference, and waist-to-hip ratio do not predict cardiovascular disease risk any better when physicians recorded systolic blood pressure, history of diabetes and cholesterol levels, researchers reported in The Lancet. The research group used individual records from 58 prospective studies with at least one year of follow up. In each study, participants were not selected on the basis of having previous vascular disease. Each study provided baseline for weight, height, and waist and hip circumference. Cause-specific mortality or vascular morbidity were recorded according to well d...

Guidelines for IVC filters differ

Notes from Dr. RW — Wed, 16 Mar 2011 11:28:00 +0100

(Source: Notes from Dr. RW)

Is Turbulence Good For The Heart?

Better Health — Sat, 05 Mar 2011 15:00:27 +0100

It’s hard to believe that turbulence could be a good thing for the heart. Consider how the word turbulent is defined: “Characterized by conflict, disorder, or confusion; not controlled or calm.” Those traits don’t sound very heart-healthy. But when it comes to heart rhythm, it turns out that a turbulent response — to a premature beat — is better than a blunted one. The more turbulent the better. No, you haven’t missed anything, and turbulence isn’t another of my typos. Until [recently], heart rate turbulence was an obscure phenomenon buried in the bowels of heart rhythm journals. What Is Heart Rate Turbulence (HRT)? When you listen to the heart of a young physically-fit patient, you are struck not just by the slowness of the heartbeat, but also by the variability...

More Potassium, Fewer Strokes

Better Health — Fri, 04 Mar 2011 18:00:00 +0100

There are few medical conditions that people fear more than a stroke. We know that blood pressure control and lowering cholesterol levels reduces stroke risk. Now, thanks to a huge analysis from Italy published in the Journal of the American College of Cardiology, we know that higher dietary consumption of potassium is associated with lower rates of stroke and could also reduce the risk of coronary heart disease and total cardiovascular disease, too. What is even more remarkable is that the results apply to all parts of society and not just to specific “at-risk” subgroups. Most doctors aren’t even aware of how important it is to eat potassium-rich foods. And what are these foods that have potassium? Surprise: It’s fruits and vegetables like bananas, tomatoes, o...

Controlling Hypertension without Drugs

MD Buyline — Thu, 03 Mar 2011 14:43:18 +0100

Two very different, cutting edge technologies are on the verge of becoming an option for patients with drug-resistant hypertension. I find this very exciting, considering hypertension affects almost 1/3 of adult Americans. It’s a deadly disease that costs $76 billion a year to treat. Out of this patient mix, 20 to 30% of those diagnosed with hypertension are unable to control its affects with lifestyle changes or medication. I spoke to Geoffrey S.F. Ling, MD, PhD, director of Critical Care, Department of Anesthesiology and Critical Care Medicine, professor and vice chair of Neurology Uniform Services, University of Health Services, and advisory panel of National Neurological Disorder and Stroke Institute at NIH, Bethesda, Md., on the problems of controlling high blood pressure. H...

Pharmalot… Pharmalittle… Good Morning

Pharmalot — Thu, 03 Mar 2011 12:00:30 +0100

Rise and shine, everyone, another shiny day is on the way. What lies in store? Meetings and deadlines, no doubt, and we relate. To cope, we are brewing our mandatory cup of stimulation and invite you to join us. Meanwhile, we will pause to hustle one of the short people off to the local schoolhouse. So here are a few tidbits. Also, please note that we posted some items last night, but placed them above our morning greeting in the event some people did not see them. Have a great day and stay in touch… Traditional Drug Discovery Model Is Ripe For Reform (Nature) McKesson Fights $212M Pricing Fine Levied By Arizona (Courthouse News) Lilly To Outsource Bioanalytical Work (Pharma Times) Eisai To Cut 900 Jobs Over Five Years (Bloomberg News) Panel Told No Guarantees Against Unethical Resea...

Pradaxa pearls

Notes from Dr. RW — Thu, 03 Mar 2011 03:13:00 +0100

(Source: Notes from Dr. RW)

Mendelian cardiovascular disorders

Notes from Dr. RW — Wed, 02 Mar 2011 13:19:00 +0100

(Source: Notes from Dr. RW)

The latest on carotid artery stenting versus surgery

Notes from Dr. RW — Wed, 02 Mar 2011 13:16:00 +0100

(Source: Notes from Dr. RW)

Pharmalot… Pharmalittle… Good Morning

Pharmalot — Wed, 02 Mar 2011 12:40:14 +0100

Hello, everyone, and nice to see you again. A mild and sunny day is unfolding here on the Pharmalot corporate campus, where the dogs are barking and a needed cup of stimulation is brewing. What does today hold in store? Meetings and deadlines, no doubt. We relate. So to help you along, we have gathered a few tidbits. Let us know if you come across something noteworthy yourselves. Meanwhile, have a good one… FDA Rejects MS Pill From Merck KGgA (Reuters) Roche Gets EU Backing For Avastin For Breast Cancer (MarketWatch) Celgene Discloses Fed Probe Of Cancer Drug Marketing (Dow Jones) Glaxo Offer To Pay Trainee Tuition Fees (BBC News) Glaxo HIV Drugs Not Tied To Heart Risks (Bloomberg News) Judge Rules Patent Settlement Documents To Remain Sealed (Dow Jones) Poor Health Literacy Leads To...

MRI contrast and nephrogenic systemic fibrosis

Notes from Dr. RW — Tue, 01 Mar 2011 13:07:00 +0100

(Source: Notes from Dr. RW)

More evidence that preoperative statin therapy is beneficial

Notes from Dr. RW — Mon, 28 Feb 2011 11:12:00 +0100

(Source: Notes from Dr. RW)

Use of proton pump inhibitors with thienopyridines

Notes from Dr. RW — Fri, 25 Feb 2011 11:50:00 +0100

(Source: Notes from Dr. RW)

Electrocardiographic differentiation of narrow complex tachycardias

Notes from Dr. RW — Fri, 25 Feb 2011 11:48:00 +0100

(Source: Notes from Dr. RW)

Duration of anticoagulation after VTE

Notes from Dr. RW — Fri, 25 Feb 2011 11:40:00 +0100

(Source: Notes from Dr. RW)

Tetralogy of Fallot all grown up

Notes from Dr. RW — Thu, 24 Feb 2011 14:42:00 +0100

(Source: Notes from Dr. RW)

High Triglycerides Associated With High Stroke Risks

FuturePundit — Thu, 24 Feb 2011 00:00:00 +0100

If you are eating a white flour and sugar diet beware what risk you could be running with your brain. After adjusting for age, hypertension, smoking, alcohol consumption, atrial fibrillation, lipid-lowering therapy, and in women hormone replacement therapy and menopausal status, the researchers found that women with a nonfasting triglyceride level above 445 mg/dL (5 mmol/L) had a 4-fold increased risk for stroke compared with women with a nonfasting triglyceride level below 90 mg/dL (1 mmol/L). The corresponding risk in men was a 2.3-fold increased risk. Results like this one underscore in my mind the value of tracking your body's biochemical state at fairly frequent intervals. A friend recently described to me how his triglycerides skyrocketed when he... (Source: FuturePundit)

Coronary Stent Thrombosis And Your Body Clock

Better Health — Wed, 23 Feb 2011 14:00:00 +0100

Add coronary stent thrombosis to the list of cardiac events influenced by circadian rhythms, with more events occurring during the early morning hours and in a summertime window of late July and early August. Coronary stent thrombosis joins several other adverse cardiac events that also follow a circadian pattern, such as stroke, unstable angina pectoris, acute myocardial infarction and sudden cardiac death, according to researcher published in JACC: Cardiovascular Interventions. Most studies that addressed circadian variations in cardiovascular disease were done before the advent of stents, so, researcher from Mayo Clinic-Rochester conducted a retrospective analysis of medical records and the clinic’s registry, finding 124 patients who presented with coronary stent thrombosis betwee...

About White-Coat Hypertension

Better Health — Mon, 21 Feb 2011 20:00:00 +0100

“But doc, my blood pressure is always normal at home.” I wish I had a dollar for every time I have heard that line and I know it is true. When some patients come to see me, their blood pressure is abnormally high (above 130/90). This is known as “white-coat hypertension.” Although it has been thought to be from anxiety about seeing the doctor, even long-established patients who have no conscious anxiety can exhibit elevated blood pressure in the office. Because blood pressure naturally fluctuates and the office visit is not a “normal” setting, it is important for patients who have high blood pressure (hypertension) to have their own blood pressure cuff at home. Now that devices are automated and easy to use, everyone with hypertension should be mo...

Diet Soda And Your Risk For Heart Attack Or Stroke

Better Health — Sun, 20 Feb 2011 14:00:45 +0100

It tastes sweet. It’s pleasurably fizzy. And free of calories. What’s more, the FDA says NutraSweet (aspartame) is safe. So what’s not to like about diet soft drinks? A bunch. The ongoing debate about the healthiness of diet soft drinks reminds me of the old adage, “If something sounds to be true, it probably is.” Artificially-sweetened “diet” drinks get touted as healthy alternatives to sugary drinks because they contain no calories or carbohydrates. On paper it seems plausible to think they are inert, no more dangerous than water. The Coca-Cola Company sublimely strengthens this assertion by putting a big red heart on Diet Coke cans. But diet-cola news (Los Angeles Times) presented at the International Stroke Conference 2011 suggests otherwise. This widely-publ...

Long term mortality after PE

Notes from Dr. RW — Fri, 18 Feb 2011 15:47:00 +0100

(Source: Notes from Dr. RW)

The electrocardiogram and the severity of COPD

Notes from Dr. RW — Fri, 18 Feb 2011 11:15:00 +0100

(Source: Notes from Dr. RW)

Natriuretic peptide testing in the ER

Notes from Dr. RW — Fri, 18 Feb 2011 11:06:00 +0100

(Source: Notes from Dr. RW)

Systemic lupus erythematosus and accelerated atherosclerosis

Notes from Dr. RW — Thu, 17 Feb 2011 13:10:00 +0100

(Source: Notes from Dr. RW)

Electrocardiography and echocardiography in the diagnosis of cardiac amyloidosis

Notes from Dr. RW — Thu, 17 Feb 2011 13:04:00 +0100

(Source: Notes from Dr. RW)

Statins don't change the small dense LDL phenotype

Notes from Dr. RW — Tue, 15 Feb 2011 13:00:00 +0100

(Source: Notes from Dr. RW)

Update on chronic tachycardia-induced cardiomyopathy

Notes from Dr. RW — Mon, 14 Feb 2011 13:06:00 +0100

(Source: Notes from Dr. RW)

Still The “Incredible, Edible” Egg

Better Health — Sat, 12 Feb 2011 20:00:00 +0100

Enriched chicken feed may have resulted in eggs having less cholesterol and more Vitamin D than previously measured, reports the U.S. Department of Agriculture (USDA). A large egg today has about 185 milligrams of cholesterol, down 14 percent from 215 milligrams in 2002, according to new research from the USDA’s Agricultural Research Service, reports USA Today. Also, an egg today has 41 international units (IUs) of Vitamin D, up 64 percent from 25 IUs measured in 2002. (That’s still only about 7 percent of the 600 IUs recommended per day.) The agency regularly does nutrient checks on popular foods, this time analyzing eggs taken from store shelves in 12 locations around the country. The American Egg Board said in a press release that hen feed is made up mostly of corn, soyb...

The (Still) “Incredible, Edible” Egg

Better Health — Sat, 12 Feb 2011 20:00:00 +0100

Flecainide 22 years after CAST: safe at last? (For atrial fib, that is)

Notes from Dr. RW — Fri, 11 Feb 2011 11:25:00 +0100

(Source: Notes from Dr. RW)

The Forecast For Heart Disease: Gloomy With A Chance Of “Boomers”

Better Health — Thu, 10 Feb 2011 18:00:43 +0100

As a youngster, I loved being part of the baby boom — it meant there were dozens of kids on my block who were ready to play hide-and-seek or join mysterious clubs. Now that I’m of an AARP age, there’s one club I don’t want to join: The one whose members have bypass scars, pacemakers, or other trappings of cardiovascular disease. The American Heart Association’s (AHA) gloomy new forecast on cardiovascular disease tells me it won’t be easy to avoid. The AHA foresees sizeable increases in all forms of cardiovascular disease (see table) between now and 2030, the year all of the boomers are age 65 and older. Those increases will translate into an additional 27 million people with high blood pressure, eight million with coronary heart disease, four million with stroke, and thr...

The wheels of translation (of evidence into practice) turn slowly

Notes from Dr. RW — Tue, 08 Feb 2011 12:34:00 +0100

(Source: Notes from Dr. RW)

Pradaxa's unusually short shelf life

Notes from Dr. RW — Mon, 07 Feb 2011 16:39:00 +0100

(Source: Notes from Dr. RW)

Distinguishing LV aneurysm from acute anterior STEMI

Notes from Dr. RW — Mon, 07 Feb 2011 11:32:00 +0100

(Source: Notes from Dr. RW)

Is February Heart-Marketing Month?

Better Health — Sun, 06 Feb 2011 22:00:00 +0100

Heart disease and February: What relationship could be more cozy? From the scary risks of shoveling snow (yep, you could die, so be sure to lift a little at a time), Mercedes-sponsored red dress parades and government-sponsored National Wear Red Day®, to tips for identifying heart attacks in women (men, you need a different month I guess), February has all the important stories to improve your awareness. Such a polite term “awareness.” But I wonder, now that the Internet is upon us and people are seeing their insurance rates and co-pays skyrocket, if maybe we’re shooting ourselves in the foot with all this heart-month marketing hype. People are sick and tired of testing “just to be sure.” It’s starting to directly cost them a fortune, and people are fr...

Putting Your Heart Into The Super Bowl

Better Health — Sun, 06 Feb 2011 16:00:00 +0100

Sports fans may literally live and die on their team’s victories, according to researchers who examined cardiac mortality rates after the home team won and lost the Super Bowl. Total and cardiac mortality rates in Los Angeles County increased after the football team’s 1980 Super Bowl loss but overall mortality fell after the 1984 the team’s Super Bowl win, researchers concluded from a review of death certificates reported in Clinical Cardiology. First, authors gave a clinical review. Stress causes a cardiac cascade. The sympathetic nervous system increases and releases catecholamines. This triggers a rise in heart rate and blood pressure, and ventricular contractility increases oxygen demand, causing blood the sheer against and fracture atherosclerotic plaque, the authors...

Acute exercise has immediate effects on postprandial lipemia and insulin levels

Notes from Dr. RW — Fri, 04 Feb 2011 11:54:00 +0100

(Source: Notes from Dr. RW)

Anthracycline induced cardiomyopathy

Notes from Dr. RW — Thu, 03 Feb 2011 12:29:00 +0100

(Source: Notes from Dr. RW)

MRI in patients with pacemakers

Notes from Dr. RW — Thu, 03 Feb 2011 11:27:00 +0100

(Source: Notes from Dr. RW)

Book Review: “Why We Get Fat: And What To Do About It”

Better Health — Wed, 02 Feb 2011 14:00:44 +0100

Journalist Gary Taubes created a stir in 2007 with his impressive but daunting 640-page tome Good Calories, Bad Calories. Now he has written a shorter, more accessible book Why We Get Fat: And What to Do About It to take his message to a wider audience. His basic thesis is that: - The calories-in/calories-out model is wrong. - Carbohydrates are the cause of obesity and are also important causes of heart disease, type 2 diabetes, cancer, Alzheimer’s, and most of the so-called diseases of civilization. - A low-fat diet is not healthy. - A low-carb diet is essential both for weight loss and for health. - Dieters can satisfy their hunger pangs and eat as much as they want and still lose weight as long as they restrict carbohydrates. He supports his thesis with data from the scientific litera...

Pacemaker and AICD related infections

Notes from Dr. RW — Wed, 02 Feb 2011 13:08:00 +0100

(Source: Notes from Dr. RW)

How many patients with incident heart failure undergo assessment of LVEF?

Notes from Dr. RW — Wed, 02 Feb 2011 13:04:00 +0100

(Source: Notes from Dr. RW)

Familial risk factors for coronary disease

Notes from Dr. RW — Wed, 02 Feb 2011 13:02:00 +0100

(Source: Notes from Dr. RW)

Cardiovascular Care: Costs Could Triple By 2030

Better Health — Tue, 01 Feb 2011 18:00:00 +0100

Real total direct medical costs of cardiovascular disease (CVD) could triple, from $273 billion to $818 billion (in 2008 dollars) by 2030. Real indirect costs, such as lost productivity among the employed and unpaid household work, could increase 61 percent, from $172 billion in 2010 to $276 billion. Results appeared in a policy statement of the American Heart Association. CVD is the leading cause of mortality and accounts for 17 percent of national health expenditures, according to the statement. How much so? U.S. medical expenditures rose from 10 percent of the Gross Domestic Product in 1985 to 15 percent in 2008. In the past decade, the medical costs of CVD have grown at an average annual rate of 6 percent and have accounted for about 15 percent of the increase in medical spending...

Podcast: Stroke – Prevention of Cardiovascular Disease

Sarasota Neurology — Mon, 31 Jan 2011 17:53:40 +0100

In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized expert in stroke prevention, provides an overview of current techniques for preventing and managing risk of stroke. Stroke is the third leading cause of death in the United States. This combined with heart attacks and heart disease result in over 2 million deaths a year. The common underlying cause is vascular disease or hardening of the arteries. Heart attack and stroke can be prevented with simple life style changes and medications. Treatment of high cholesterol, high blood pressure, aspirin and stop smoking will significantly lower risk of suffering from these devastating conditions. Listen to this report to find out how you can reduce your risk of suffering from a stroke, heart attack or other cardiovascu...

More evidence regarding the impact of industry supported CME on treatment choices

Notes from Dr. RW — Mon, 31 Jan 2011 13:07:00 +0100

(Source: Notes from Dr. RW)

Stress In Life: Respond Differently And Live Longer?

Better Health — Fri, 28 Jan 2011 17:00:39 +0100

This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up. Definitely less suffering. Maybe less deaths. The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work dist...

Blood ammonia and lactate levels after cardiac arrest as predictors of outcome

Notes from Dr. RW — Fri, 28 Jan 2011 12:50:00 +0100

(Source: Notes from Dr. RW)

Cardiologist who presented data on misread echos fired by her institution

Notes from Dr. RW — Thu, 27 Jan 2011 11:24:00 +0100

(Source: Notes from Dr. RW)

Small troponin bumps within the normal range

Notes from Dr. RW — Thu, 27 Jan 2011 11:19:00 +0100

(Source: Notes from Dr. RW)

A Good Year for Cath Lab Financial Incentives

MD Buyline — Tue, 25 Jan 2011 14:54:41 +0100

What a difference a year makes in cath lab reimbursement! I was updating one of our cath lab calculators for projecting revenue and was surprised; the 2011 inpatient rates for both diagnostic and therapeutic cath lab reimbursement will increase between 3% and 5%. Although this doesn’t seem too dramatic, it reverses the 2009 to 2010 .03% and .5% increases. Administrators should keep an eye on several codes for increased inpatient cath lab reimbursement: DRG 247 (percutaneous cardiovascular procedure with drug-eluting stents) and DRG 287 (circulatory disorders except MI with cardiac cauterization), both of which increased 3 to 5%. However, the most significant increase was DRG 251 (percutaneous cardiovascular procedure without stents) as this code had a 10% payment increase in the la...

Is deviation from practice guidelines a crime?

Notes from Dr. RW — Mon, 24 Jan 2011 15:33:00 +0100

(Source: Notes from Dr. RW)

Should you hold or continue ACEIs and ARBs prior to surgery?

Notes from Dr. RW — Fri, 21 Jan 2011 13:05:00 +0100

(Source: Notes from Dr. RW)

Transcutaneous pacing and the problem of false capture

Notes from Dr. RW — Fri, 21 Jan 2011 13:02:00 +0100

(Source: Notes from Dr. RW)

Merck's Vorapaxar: Bleeding, Indeed

In the Pipeline — Thu, 20 Jan 2011 13:54:59 +0100

So, as had been suspected, the reason that Merck's thrombin antagonist vorapaxar ran into clinical trouble was excessive bleeding. This is always the first thing to suspect when an anticoagulant has difficulty in human trials. It's really a delicate balance, the human clotting cascade, and it's all too easy to end up on the wrong side of it. When you think about it, the whole pathway has to be under very tight regulation - I mean, here's the fluid that transports oxygen and nutrients and removes waste. Absolutely crucial to the life of every cell in the body. And here's an option to have that fluid thicken up and turn to jelly, very quickly, and once it happens it can't be reversed. No, you're going to want a lot of safeguards around that switch. But if you lean over too far the other way...

Chocolate and Cardiovascular Health Benefits

Dr Shock MD PhD — Wed, 19 Jan 2011 07:12:51 +0100

Two recent large epidemiological studies again suggest a beneficial effect of chocolate consumption on cardiovascular disease. One study was a prospective study in 1216 women with a follow up of 9,5 years. The frequency of chocolate consumption was categorized in three groups”: < 1 serving per week, 1-6 servings and 7 or more. Outcome was defined as plaque thickness in the carotid artery and hospitalization or death at follow up as clinical outcome. Not only were carotid plaques less prevalent in those women eating more chocolate but also those who ate more chocolate were less frequently hospitalized or death from ischemic heart disease. In a large German study with middle aged participants of both sexes without cardiovascular disease at inclusion also an inverse relationship betwee...

More on not so benign early repolarization

Notes from Dr. RW — Tue, 18 Jan 2011 13:01:00 +0100

(Source: Notes from Dr. RW)

Non-guideline based ICD implantation

Notes from Dr. RW — Mon, 17 Jan 2011 13:11:00 +0100

(Source: Notes from Dr. RW)

Acute liver failure associated with dronedarone (Multaq)

Notes from Dr. RW — Mon, 17 Jan 2011 13:06:00 +0100

(Source: Notes from Dr. RW)

Poor R wave progression in the electrocardiogram in diabetes

Notes from Dr. RW — Fri, 14 Jan 2011 12:49:00 +0100

(Source: Notes from Dr. RW)

What is the effectiveness of the AED in hospitalized patients?

Notes from Dr. RW — Thu, 13 Jan 2011 13:24:00 +0100

(Source: Notes from Dr. RW)

Results of a community wide campaign to improve cardiac resuscitation

Notes from Dr. RW — Mon, 03 Jan 2011 11:53:00 +0100

(Source: Notes from Dr. RW)

What's new in CPR and emergency cardiac care in 2010 and what does it mean for hospital systems of care?

Notes from Dr. RW — Tue, 28 Dec 2010 11:27:00 +0100

(Source: Notes from Dr. RW)

Review of cardiac amyloidosis

Notes from Dr. RW — Thu, 23 Dec 2010 14:35:00 +0100

(Source: Notes from Dr. RW)

Another STEMI equivalent that's not technically a STEMI: posterior infarction

Notes from Dr. RW — Wed, 22 Dec 2010 13:06:00 +0100

(Source: Notes from Dr. RW)

Another SVT mimic

Notes from Dr. RW — Tue, 21 Dec 2010 11:40:00 +0100

(Source: Notes from Dr. RW)

Acute RV failure understudied and underappreciated

Notes from Dr. RW — Mon, 20 Dec 2010 11:50:00 +0100

(Source: Notes from Dr. RW)

Update on short QT syndrome

Notes from Dr. RW — Mon, 20 Dec 2010 11:45:00 +0100

(Source: Notes from Dr. RW)

A Flat Belly is in your Sole

Timemaster MD — Mon, 20 Dec 2010 03:55:44 +0100

Fat Burning Secret is in the sole of your shoes – fat busting is measured in how many steps run, not reps you pull! New science says your best way to slim and sexy is running, not lifting weights! Monitoring Fat Loss in Runners A key finding in a German study on long distance runners show that the first tissue affected by running was fat tissue! More importantly, visceral fat loss -the most dangerous fat linked to cardiovascular disease goes away. This is big news! Liposuction cannot reach inside your guts to get to the fat It has always been dogma, that when you put yourself in a negative calorie state through dieting or catabolic exercise, that your body burns protein (or muscle) first, not fat. We have always used hormones to protect the fat which works well. But, thi...

Ictal asystole---when the brain stops the heart

Notes from Dr. RW — Thu, 16 Dec 2010 13:51:00 +0100

(Source: Notes from Dr. RW)

Right ventricular infarction---clues from the standard 12 lead

Notes from Dr. RW — Mon, 13 Dec 2010 20:11:00 +0100

(Source: Notes from Dr. RW)

Decline In Stroke Deaths Reinforces “Brain Attack” Prevention

Better Health — Mon, 13 Dec 2010 13:00:25 +0100

Stroke killed 2,000 fewer Americans in 2008 (the last year with complete numbers) than it did in 2007, the Centers for Disease Control and Prevention (CDC) said yesterday in its latest annual Deaths report. That dropped stroke from the third leading cause of death in the United States to the fourth. Good news? Yes and no. It’s always good news when fewer people die. The reduction suggests a payoff for efforts to prevent stroke and improve the way doctors treat it. Yet the drop from third to fourth place is due largely to an accounting change. The CDC reorganized another category, “chronic lower respiratory diseases” (mainly chronic bronchitis and emphysema), to include complications of these diseases such as pneumonia. The change substantially increased the number of deaths in this c...

Upper extremity DVT secondary to PICC insertion

Notes from Dr. RW — Thu, 09 Dec 2010 12:41:00 +0100

(Source: Notes from Dr. RW)

New appropriateness criteria for cardiac CT

Notes from Dr. RW — Wed, 08 Dec 2010 13:11:00 +0100

(Source: Notes from Dr. RW)

Incidence of Takotsubo cardiomyopathy peaks on Monday

Notes from Dr. RW — Tue, 07 Dec 2010 11:43:00 +0100

(Source: Notes from Dr. RW)

The risk of recurrent VTE after stopping therapy

Notes from Dr. RW — Tue, 07 Dec 2010 11:28:00 +0100

(Source: Notes from Dr. RW)

STEMI changes can be fleeting

Notes from Dr. RW — Mon, 06 Dec 2010 12:51:00 +0100

(Source: Notes from Dr. RW)

Practical aspects of using dabigatran

Notes from Dr. RW — Fri, 03 Dec 2010 12:11:00 +0100

(Source: Notes from Dr. RW)

The safety of statin drugs in patients with abnormal liver function tests---the GREACE study

Notes from Dr. RW — Thu, 02 Dec 2010 19:15:00 +0100

(Source: Notes from Dr. RW)

Even more evidence on the importance of lead aVR

Notes from Dr. RW — Tue, 30 Nov 2010 15:41:00 +0100

(Source: Notes from Dr. RW)

Diagnosis of acute MI in the presence of left bundle branch block

Notes from Dr. RW — Tue, 30 Nov 2010 15:38:00 +0100

(Source: Notes from Dr. RW)

VTE prophylaxis for hospitalized medical patients

Notes from Dr. RW — Mon, 29 Nov 2010 14:31:00 +0100

(Source: Notes from Dr. RW)