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Condition: Heart Failure
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EMPEROR-Preserved Clinical Trial Review
EMPEROR-Preserved Clinical Trial is an important study which has shown benefit in patients with heart failure and a preserved ejection fraction (HFpEF) [1].
It was a double blind randomized trial in which 5988 patients with class II-IV heart failure and ejection fraction above 40% were allocated to receive empagliflozin 10 mg daily or placebo, in addition to usual therapy.
The median ejection fraction noted in the study patients was 54%, with two thirds of patients having a left ventricular ejection fraction of 50% or more.
Primary outcome measure in the study was a composite of cardiovascular death or hospitalization for...
Source: Cardiophile MD - September 2, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
P2-CHA2DS2-VASc Score
P2-CHA2DS2-VASc score adds additional two points to the CHA2DS2-VASc score for an abnormal P wave axis to predict risk of stroke in atrial fibrillation (AF) [1]. The seminal study was an attempt to identify utility of P wave indices in sinus rhythm to predict the risk of stroke over and above the existing CHA2DS2-VASc score. P wave indices evaluated were prolonged P wave duration, abnormal P wave axis, advanced interatrial block and abnormal P wave terminal force in lead V1. They found that abnormal P wave axis which is an ECG correlate of left atrial abnormality improves the prediction of ischemic stroke. They concluded ...
Source: Cardiophile MD - July 21, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Hypotension, altered mental status, and aVR sign - activate the cath lab?
ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.
Source: Dr. Smith's ECG Blog - July 21, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, July 19th 2021
In this study, we developed the first epigenetic clock for domesticated sheep (Ovis aries), which can predict chronological age with a median absolute error of 5.1 months. We have discovered that castrated male sheep have a decelerated aging rate compared to intact males, mediated at least in part by the removal of androgens.
Furthermore, we identified several androgen-sensitive CpG dinucleotides that become progressively hypomethylated with age in intact males, but remain stable in castrated males and females. Comparable sex-specific methylation differences in MKLN1 also exist in bat skin and a range of mouse tissu...
Source: Fight Aging! - July 18, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Cardiology MCQs
Which of the following is an innocent murmur?
Gibson’s murmur
Roger’s murmur
Still’s murmur
Dock’s murmur
Correct answer: 3. Still’s murmur
Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmur heard in the lower left sternal area. It is best heard with the bell of the stethoscope. Still’s murmur is a mid systolic murmur, loudest in supine position and diminishes in intensity on sitting and standing as venous return decreases [Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689]. Gibson’s murmur is the train-in-tunnel murmur or ma...
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Ischemic ST depression maximal in V1-V4 (vs. V5-V6), even if less than 0.1 millivolt, is specific for Occlusion Myocardial Infarction (vs. subendocardial non-occlusive ischemia)
Conclusion: Among high-risk ACS patients, the specificity for OMI of suspected ischemic STDmaxV1-4 was 97%. STEMI criteria missed half of OMIs detected by STDmaxV1-4. These data support that any ischemic STD maximal in V1-V4 in ACS is due to OMI until proven otherwise.
Source: Dr. Smith's ECG Blog - June 27, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Coronary venous circulation
Importance of knowing the coronary venous circulation has increased in recent years with use of cardiac resynchronization therapy (CRT) for heart failure. Left ventricular epicardial pacing in CRT is achieved by placing a lead in a coronary vein, usually a posterolateral tributary of the coronary sinus.
Coronary venous circulation can be visualized by a coronary angiogram levophase. After filling the coronary arteries, the contrast drains into the coronary venous system, finally opacifying the coronary sinus, which drains into the right atrium. Here is a coronary angiogram levophase, with a line diagram beside it:
Coronar...
Source: Cardiophile MD - June 26, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Congenitally corrected transposition of great arteries
Congenitally corrected transposition of the great arteries (CCTGA or cTGA) is a condition in which there is atrioventricular and ventricular arterial discordance so that the circulation is physiological. Congenitally corrected transposition of great arteries is also known as l-transposition of great arteries (l-TGA) because of the levo transposition of aorta. Levo posed aorta forms a hump along the left upper heart border on chest X-ray.
The right atrium connects to the morphological left ventricle, which in turn connects to the pulmonary artery so that systemic venous blood reaches the pulmonary circulation. The left atr...
Source: Cardiophile MD - June 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Left ventricular reverse remodeling
In this study, change in LVESV was the single most important predictor of all cause and cardiovascular mortality. Clinical parameters could not predict outcome events in this study.
Similar beneficial effect on left ventricular remodeling was demonstrated long back in the trials with angiotensin converting enzyme inhibitors. SOLVD (Studies of Left Ventricular Dysfunction) study showed that in patients with heart failure and reduced left ventricular ejection fraction, chronic treatment with angiotensin converting enzyme inhibitor enalapril prevented progressive left ventricular dilatation, systolic dysfunction and increase ...
Source: Cardiophile MD - June 11, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man ' s life
Case submitted and written by Dr. Jesse McLaren (@ECGcases), ofEmergency Medicine CasesReviewed by Pendell Meyers and Steve SmithAn 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. On arrival, GCS was 13 and the patient complained of ongoing chest pain. Vitals were HR 58 BP 167/70 R20 sat 96%. Below is the first ED ECG, labeled LBBB by the machine. Are there any indicat...
Source: Dr. Smith's ECG Blog - June 11, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
GALACTIC-HF Trial: Omecamtiv mecarbil
GALACTIC-HF trial evaluated omecamtiv mecarbil, a cardiac myosin activator in heart failure with reduced ejection fraction [1]. The study had 8256 patients which included inpatients and outpatients with symptomatic heart failure with an ejection fraction of 35% or less. It was a placebo controlled trial of omecamtiv mecarbil in addition to standard heart failure therapy.
Primary outcome was a composite of first heart failure event or death from cardiovascular causes. Heart failure event was defined as hospitalization or urgent hospital visit for heart failure. Over a median follow up of 21.8 months, primary outcome event ...
Source: Cardiophile MD - June 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Metabolic modulation in heart failure
Most of the treatment strategies in heart failure like angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI) and beta blockers utilize hemodynamic modulation. Metabolic modulation on the other hand aims at dealing with myocardial energetic deficiency. Important agents in this group are trimetazidine, ranolazine and perhexiline [1]. Trimetazidine is a 3-ketoacyl coenzyme A thiolase inhibitor, while ranolazine inhibits the late sodium current. Perhexiline inhibits carnitine palmitoyl transferase.
A meta-analysis on trimetazidine published in ...
Source: Cardiophile MD - May 23, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
