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Total 89 results found since Jan 2013.

To Bind or Not to Bind?
An 88-year-old man with a history of congestive heart failure, hypertension, and diabetes mellitus presented to the ED from a nursing home with altered mental status. EMS reported that the patient has had a decreased appetite, diarrhea, and weakness for three days. His initial vital signs were temperature 97.9°F, heart rate 79 bpm, blood pressure 116/64 mm Hg, respiratory rate 16 bpm, and pulse oximetry 98% on room air. His physical exam was remarkable for a depressed level of consciousness. Lab findings showed a creatinine of 2.6 mg/dl, a BUN of 60 mg/dl, and normal potassium and magnesium. His ECG is shown below.   ...
Source: The Tox Cave - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Say “NO” to statins
15-month “before” and “after” 2-year “before” and “after” Along with her obvious physical transformation, Tanya experienced other positive changes in health, including an improvement in her cholesterol panel, with wheat elimination. I’ll let Tanya tell her story: “I first heard about you on Dr. Oz. I thought this lifestyle of yours was way to complicated for me to follow, so I didn’t buy your book. Instead, I was at work and my coworkers were talking about your book. One of my coworkers was a severe diabetic, and she was talking to another coworker about ho...
Source: Wheat Belly Blog - October 14, 2014 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle cholesterol HDL LDL statin triglycerides Weight Loss Source Type: blogs

Let’s stop the unnecessary treatment of heart disease
There are many reasons doctors suffer from burnout and compassion fatigue. One of the least-mentioned of these reasons is that much of what we do is so damn unnecessary. In the US, the land of excess everything, caregivers, especially cardiologists, spend most of our time treating human beings that didn’t need to have disease. Let’s be clear and honest: Lifestyle-related disease is largely unnecessary. These days, there is so much unnecessary disease that caregivers, especially cardiologists, rarely see it. We look past the obesity right to the cholesterol number and ECG. And then we pull out the prescription pad for t...
Source: Dr John M - October 3, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low. Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also. This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek) Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs

Beta 3 adrenoceptors are cardioprotective
Beta 3 adrenoceptors were described in 1980. They increase lipolysis, oxidation of fats, expenditure of energy and the action of insulin. Hence they have been thought to be important target for the treatment of diabetes mellitus and obesity [de Souza CJ et al. Beta 3-adrenoceptor agonists as anti-diabetic and anti-obesity drugs in humans. Curr Pharm Des. 2001;7:1433-49]. Cardioprotective action of beta 3 adrenoceptors Beta 3 adrenoceptors are stimulated only at high concentration of catecholamines, inducing negative inotropic effect and act as protection from overstimulation by catecholamines [Xiaolin Niu et al, Cardiopro...
Source: Cardiophile MD - August 27, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Is this the most important cardiology study of the last decade?
In recent years, progress in the field of cardiology has been painfully incremental. We have enjoyed small gains–a better ablation catheter and mapping system, a couple of new anti-platelet drugs, maybe better stents, and even the highly touted anticoagulant drugs are within 99% in efficacy and safety of warfarin. Major breakthroughs, though, are non-existent. (And please don’t tell me squishing valves in the frail elderly is a major advance.) This absence of game-changing type progress has an explanation. Perhaps the answer will be obvious after I tell you about the most important cardiology medical study of t...
Source: Dr John M - August 27, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

ACE Inhibitors and anemia
: Angiotensin converting enzyme (ACE) inhibitors have been implicated in the worsening of anemia in patients with chronic kidney disease (CKD) on dialysis and renal transplant recipients. Both ACE inhibitors and angiotensin receptor blockers (ARB) have some effect on erythropoietin synthesis and can cause suppression of erythropoiesis in those with CKD. This can sometimes be overcome by escalating the dose of exogenously administered erythropoietin. It is known that activation of renin-angiotensin system enhances the production of erythropoietin in peritubular fibroblasts of the kidney. Some studies also suggest that ACE i...
Source: Cardiophile MD - August 23, 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 041
This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values? Recommended by: Jerremy Fried Read More: Age Adjusted D-Dimer Testing (RE...
Source: Life in the Fast Lane - July 29, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 037
Conclusion: Use of an age-adjusted d-dimer threshold reduces imaging among patients age <50 years with a Revised Geneva Score ≤ 10. While the adoption of an age-adjusted d-dimer threshold is probably safe, the confidence intervals surrounding the additional 1.5% of PE that was missed using an age-adjusted threshold necessitate a prospective study before this practice can be adopted into routine clinical care. Recommended by: Salim R. Rezaie,  Jeremy Fried Read More: The Adventure of the Golden Standard (Rory Spiegel) Resuscitation Wik L et al. Manual vs. integrated automatic load-distributing band CPR with equal ...
Source: Life in the Fast Lane - July 2, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured General Surgery Health Infectious Disease Intensive Care Neurology Neurosurgery Radiology Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations Source Type: blogs

Failed thrombolysis in diabetes : What is the mechanism ?
Diabetes mellitus is a pro-coagulant state,especially so in severe uncontrolled states.(1) This is mediated by increased  levels of   plasminogen  activator Inhibitor.(PAI 1 and 2 This tilts  anti-fibrinolytic  forces towards thrombosis. High PAI-1 is an Independent risk factor for MI in young individuals (3) During STEMI the success rate of  fibrinolysis is significantly lower in diabetic population because high levels of PAI 1 . The triad of DM,Obesity, Insulin resistance is a powerful predictor of  poor  response to thrombolysis. Source : http://care.diabetesjournals.org/content/35/10/1961/   Reference 1...
Source: Dr.S.Venkatesan MD - March 25, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Mechnisms of disease cardiology -Therapeutics Cardiology -unresolved questions Cardiology lipids /dyslipidemia Diabetes and Heart anti fibrinolytic agents failed thrombolysis in diabetes pai 1 and 2 plaminogen activator inhibit Source Type: blogs

Diabetes or Weight — Which Comes First?
By David Spero "Everybody knows" that being fat leads to Type 2 diabetes, even though it's not true. That idea has been pretty well debunked. Reporting on a study in The Journal of the American Medical Association, Diane Fennell wrote "General measures of obesity, such as body-mass index, total body fat, or [fat under the skin] were not associated with an increased risk of developing Type 2." What seems more likely is that Type 2 diabetes makes people fat. The connection is insulin resistance. Nurse practitioner Laurie Klipfel writes, "Even thin people who are insulin resistant are at risk for the things associated with ...
Source: Diabetes Self-Management - March 5, 2014 Category: Diabetes Authors: David Spero Source Type: blogs

How Manipulated Clinical Evidence Could Distort Guidelines - the Case of Statins for Primary Prevention
This study excluded many patient for whom the statins were not contraindicated or warned against: uncontrolled hypertension; type 1 or type 2 diabetes mellitus on insulin or with a HgBA1C at least 10%; and body weight more than 50% "desirable limit for height."  (Based on the official contraindications and warnings for commonly used statins, e.g., see contraindications for Lipitor here, active liver disease, pregnancy for likely to become pregnant, nursing mothers, hypersensitivity to the medicine; and warnings: use of cyclosprine or strong CYP3A4 inhibitors, uncontrolled hypothyroidism, renal impairment.)  Thus ...
Source: Health Care Renewal - December 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association clinical trials conflicts of interest evidence-based medicine guidelines manipulating clinical research review articles Source Type: blogs

Facing the Fats
By Amy Campbell Fat is a necessary nutrient, and we need it to sustain health. But it's also had its share of hard knocks in the past, and many people (including some dietitians) are still leery about promoting its goodness. In light of the new cholesterol management guidelines from the American Heart Association and the American College of Cardiology, as well as the FDA's recent proposal to ban trans fat, I decided to write about the different types of fat in our diets this week. I won't get into either of these stories in much detail, but suffice it to say that cholesterol has been in the news big-time recently. New guid...
Source: Diabetes Self-Management - November 18, 2013 Category: Diabetes Authors: Amy Campbell Source Type: blogs

A Sweet Wide Complex Tachycardia
A 29-year-old man with history of type 1 diabetes mellitus presents with two weeks of feeling ill that became worse over the previous two days. This included a productive cough, subjective fevers, and frequent vomiting. He reports no headache, chest pain, or abdominal pain. He has had financial problems after losing his job about a month earlier, and is currently living in a local motel. His brother brought him to the emergency department for evaluation after finding him in bed confused, with vomit on the floor.   He appeared ill, and was oriented only to self. Vital signs were blood pressure 78/43 mm Hg, pulse 146 bpm, r...
Source: Spontaneous Circulation - November 12, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs