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Drug: Amiodarone

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My dear physician , don ’ t feel ashamed to prescribe Digoxin for Atrial fibrillation !
  It was delicate few minutes  in one of  my recent  visits to a corporate hospital , when I noticed an emergency physician  hesitated to follow my advice to  prescribe IV Digoxin for a patient with  Atrial fibrillation and fast ventricular rate.His fear was, his consultant, a modern day cardiologist wouldn’t like it as Amiodarone has become a default drug for atrial fibrillation in that Institution. I could sense. . .he felt so out of place to take on my suggestion. I reminded the young physician , the uniqueness  of  Digoxin and its  un-diminished value for this particular indication ,still he was rel...
Source: Dr.S.Venkatesan MD - July 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized bio ethics digoxin drugs for atrial fibrillation how to practice medicine Source Type: blogs

My dear physician , don’t feel ashamed to prescribe Digoxin for Atrial fibrillation !
  It was delicate few minutes  in one of  my recent  visits to a corporate hospital , when I noticed an emergency physician  hesitated to follow my advice to  prescribe IV Digoxin for a patient with  Atrial fibrillation and fast ventricular rate.His fear was, his consultant, a modern day cardiologist wouldn’t like it as Amiodarone has become a default drug for atrial fibrillation in that Institution. I could sense. . .he felt so out of place to take on my suggestion. I reminded the young physician , the uniqueness  of  Digoxin and its  un-diminished value for this particular indication ,still he was rel...
Source: Dr.S.Venkatesan MD - July 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized bio ethics digoxin drugs for atrial fibrillation how to practice medicine Source Type: blogs

Digoxin toxicity – Cardiology MCQ
Factor/s enhancing the risk of digoxin toxicity: a) Co-administration of verapamil b) Hypokalemia c) Hypomagnesemia d) All of the above Correct answer: d) All of the above Hypokalemia which often occurs due to the diuretic therapy which is given along with digoxin for the treatment of heart failure, potentiates the problem of digitoxicity. Correction of hypokalemia is very important in the management of digoxin toxicity. Severe hypomagnesemia can precipitate digoxin induced cardiac arrhythmia with normal serum digoxin and potassium levels and respond to correction of hypomagnesemia. Important drugs which can increase the ...
Source: Cardiophile MD - May 11, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Research and Reviews in the Fastlane 131
This study only shows an association and not causality and will need further prospective studies to elucidate the truth. However, in the absence of better evidence, either agent appears reasonable as the first line but rocuronium has a number of advantages (absence of contraindications, longer paralysis). Recommended by: Anand Swaminathan Read More: Does Succinylcholine Increase Mortality in Severe TBI Patients? (UMEM Education Pearls), Rocuronium vs. Succinycholine (Core EM) The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ th...
Source: Life in the Fast Lane - April 20, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care LITFL Neurology Pre-hospital / Retrieval Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

A Perfect Resuscitation Saves a Patient with Refractory Ventricular Fibrillation
This was contributed by Dr. Johanna Moore, one of my Hennepin Colleagues who researches CPR, along with Keith Lurie and Demetris Yannopoulos.  She translated her research knowledge into a spectacular resuscitation.Case A 54 year old male presented via ambulance to the Emergency Department (ED) in cardiac arrest. He was found down outside a clinic, where bystander CPR was initiated by clinic staff. The amount of down time was unclear but thought to be minimal as this was a high traffic pedestrian area. He received an estimated 5 minutes of manual CPR, then, after medic arrival, 20 minutes of LUCAS CPR, including u...
Source: Dr. Smith's ECG Blog - April 16, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 24
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 24. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - March 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 22
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 22. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - March 21, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 18
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 18. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 17, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

Very Bad Numbers
By ANISH KOKA, MD The date is July 17th, 2014. It is 10am in the Dirksen Senate building, and the congressional subcommittee on health and aging is about to focus on patient harm. The educating will be done by some of the leaders in the medical field, Ashish Jha and Tejal Gandhi from Harvard, Peter Pronovost from Johns Hopkins. The star of the proceedings is John James, a toxicologist, a PhD from Texas, and the founder of Patient Safety America. The tone is set from the beginning by none other than Bernie Sanders. In somber tones, he relays that hospitals can make patients worse, and that a recent study suggests medical er...
Source: The Health Care Blog - November 30, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Pulseless ventricular tachycardia – why did the AED not advise a shock?
This case was submitted by my friend Dr. Victoria Stephens.  She is a third year Emergency Medicine Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed.  Follow her on Twitter: @EMcardiac.CaseA 71 year old man was admitted to the ICU with neutropenic sepsis complicated by septic shock. He was intubated and ventilated and was started on an adrenaline infusion to maintain his blood pressure. The admission ECG was normal. Thirty-six hours into his ICU stay he went into a cardiac arrest. The monitor showed a wide complex tachycardia. CPR was commenced while...
Source: Dr. Smith's ECG Blog - April 10, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

An update on cycling and writing and video (gulp)
Hi all, Things have changed for me. I have taken on a larger role at theheart.org | Medscape Cardiology. This means I have less time for original posts here. I write and read a lot more, though. Almost every day. Writing has morphed into what cycling was: a source of contentment. It used to be that if I had a good workout, I felt good during that day. Now I get those same sensations from writing. I still exercise but its place in my self-esteem bucket is smaller. Except last Tuesday night during the local “ride,” I was dropped out of a break because of an asthma attack. That sucked. But I redeemed myself last n...
Source: Dr John M - April 8, 2015 Category: Cardiology Authors: Dr John Source Type: blogs

How much Irregular ventricular tachycardia can be ?
We know , any wide QRS tachycardias  would argue us to make a default diagnosis of VT.But,  one has to be extremely cautious to apply this rule if  wide QRS  tachycardia shows  significant irregularity in RR interval . All classical VTs are a fairly regular tachycardia (Note the  key words , fair and regular) . Small cycle length variations are observed in VT  but they are usually not discernible in surface ECG. There are no practical rules .A well  appreciable  irregularity in RR interval will seriously  question the diagnosis of classical VT. To make an another statement, most of the  irregular wide QRS tachyc...
Source: Dr.S.Venkatesan MD - March 15, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Electrophysiology -Pacemaker WPW syndrome wide qrs irregualr tachycardia wide qrs regular vs irregular tachycardia Source Type: blogs

Atrial fibrillation during STEMI : Don’t get alarmed
Atrial fibrillation is the most  common arrhythmia we encounter in clinical cardiology .Ironically it is  uncommon during ACS and extremely rare in association with UA/NSTEMI. Surprisingly , an entity ” Ischemic AF” is not to be found in cardiology literature. The incidence of AF in STEMI is less than 5%. Occurs more often due to factors other than primary ischemia of atrial musculature. Of-course , AF in association with Infero posterio MI and RVMI is an important trigger for AF.LCX disease is more often associated with AF as it gives up a consistent branch to left atrium. Though it is tempting to implicate ...
Source: Dr.S.Venkatesan MD - February 25, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation Infrequently asked questions in cardiology (iFAQs) atrial fibrillation in stemi management of atrial fibrillation during stemi Source Type: blogs

Amiodarone and thyroid dysfunction
Brief Review Amiodarone is one of the most widely used anti arrhythmic drug. It is well known that amiodarone can induce both hypothyroidism and hyperthyroidism due to the iodine content of the drug. 200 milligrams of amiodarone daily would deliver twenty to forty times the usual daily iodine intake. Amiodarone reduces 5-deiodinase activity and thereby the monodeiodination of T4 to T3. There is decreased generation of T3 and reduced clearance of rT3 (reverse T3), which accumulates. Destructive thyroiditis is due to the direct toxic effect of amiodarone and its metabolite on the thyroid follicular cells.1 It has been menti...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Research and Reviews in the Fastlane 060
This study enrolled 2500+ from whom 362 had a DVT, among them 6.3% have proximal DVT not located in common femoral or popliteal locations. This study shows a significant number of patients with proximal DVTs that a 2-point scan would miss.Recommended by: Daniel CabreraEmergency Medicine, Adminstration Gupta, M. Happy Meals for Everyone? Ann Emerg Med 2014; 64(6): 609 – 611. PMID: 25454564This excellent editorial points out the positive and negative aspects of an accompanying study (PMID: 25182541) which examined the patient and ED characteristics associated with patient satisfaction scores. Obviously, a growing ...
Source: Life in the Fast Lane - December 4, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE critical care emergency Emergency Medicine Intensive Care Press Ganey recommendations Review Source Type: blogs