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de Winter syndrome
de Winter syndrome was initially described as a new ECG sign of occlusion of proximal left anterior descending (LAD) coronary artery by Robbert J de Winter, Niels J W Verouden, Hein J J Wellens and Arthur A M Wilde, Interventional Cardiology Group of the Academic Medical Center, in 2008 as a Letter to the Editor [1]. Instead of the ST segment elevation which is typical of anterior wall infarction which occurs in total occlusion of LAD, they described anterior ST segment depression, in about 2% of cases. An ECG with typical features showing upsloping ST segment depression in anterior leads with tall symmetric T waves and l...
Source: Cardiophile MD - September 7, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology de Winter sign LAD total occlusion Source Type: blogs

What is the relationship between BMI and blood cholesterol ?
Caution: Please don’t expect much scientific content in this post. I Hope, you can spare a minute to answer this hypothetical question. What will be the shape of the curve,  If you plot BMI in the X-axis and LDL/ total cholesterol in Y-axis from a thousand normal adult populations? It will be linear for sure. Maybe a little curvilinear. Its likely J shaped with age  I think it is U shaped No, it is Inverted U Sorry, I don’t know. No one knows. Answer: Though linear relation is the one we expect, all sorts of shapes are reported in various correlation studies, making the resp...
Source: Dr.S.Venkatesan MD - August 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: clinical lipidology lipids lipid metabolism obesity acc aha esc csi lpi guidelies on lipids ada dyslipidemia inverted u j u curve bmi vs ldl lipids ldl lvels in obesity whats the relation missing link between obesity and cholesterol what i Source Type: blogs

Equipoise and Its Problems
By MICHEL ACCAD, MD I recently participated in a debate opposing me to Professor Adam Cifu on the topic of “Evidence-based medicine in the age of COVID.” The debate took place on an episode of Dr. Chadi Nabhan’s Outspoken Oncology podcast. Dr. Saurabh Jha was the moderator and he did a great job keeping us on point and asking for important clarifications when needed. It was a fun and cordial moment and I found it intellectually fruitful. You can listen to it here or on any podcast platform. The discussion strengthened my conviction that the central issue about EBM is the conflation of the role of th...
Source: The Health Care Blog - July 8, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice equipoise MICHEL ACCAD Source Type: blogs

Making telemedicine more inclusive
As a primary care physician at an academic community health care system in Massachusetts, I received a rapid introduction to telehealth this year. Within days after Massachusetts declared a state of emergency in response to the spread of COVID-19, almost all of our patient visits became telemedicine visits. Our staff reached out to patients to inform them of different ways they could get in touch with their doctor. Many would be able to gain access to health care through a health app connected to their healthcare web portal, or through a phone call or video call. The enormous potential of telehealth was apparent to me with...
Source: Harvard Health Blog - July 3, 2020 Category: Consumer Health News Authors: Meera Sunder, MBBS, MRCOG Tags: Coronavirus and COVID-19 Health Health care disparities Health trends Source Type: blogs

The Medical-Industrial Complex Pads Its Pockets As We Empty Ours
By MIKE MAGEE, MD A report this month published in the British Medical Journal found that 80% of 293 physician leaders and board members of 10 of the most influential medical associations in the United States (including the American College of Physicians, American College of Cardiology, American Psychiatric Association, Infectious Disease Society of America, American College of Rheumatology, the American Society of Clinical Oncology, Endocrine Society, American Thoracic Society, and Orthopaedic Trauma Association) received financial payments of $130 million in total for “leadership” activities between 2017 and 2019....
Source: The Health Care Blog - June 8, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Economics Health Policy Medical Industrial Complex Mike Magee Source Type: blogs

What exactly is the relationship between Hypertension and Corona ?
The mainstream (& the sidestream) medical media have already named one culprit ie hypertension (HT) as a significant comorbid entity in the current Corona pandemic. But, If we ask one direct question, how Corona and HT are linked ? , the answer is not forthcoming fluently. . Some of the thought process about the Issue. 1. Does Coronavirus relish high blood pressure on its journey to attack lungs ? Funny question you may think. The virus primarily lives and tracts through the respiratory tract to reach lungs. Viral load in bloodstream is nil or  miniscule till late stages. BP is nothing to do with what is hap...
Source: Dr.S.Venkatesan MD - May 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized what is the link between hypertension and corona outcome Source Type: blogs

What ’s a diagnosis about? COVID-19 and beyond
By MICHEL ACCAD Last month marked the 400th anniversary of the birth of John Graunt, commonly regarded as the father of epidemiology.  His major published work, Natural and Political Observations Made upon the Bills of Mortality, called attention to the death statistics published weekly in London beginning in the late 16th century.  Graunt was skeptical of how causes of death were ascribed, especially in times of plagues.  Evidently, 400 years of scientific advances have done little to lessen his doubts!  A few days ago, Fox News reported that Colorado governor Jared Polis had “pushed back against recen...
Source: The Health Care Blog - May 28, 2020 Category: Consumer Health News Authors: Christina Liu Tags: COVID-19 Medical Practice Physicians Diagnosis MICHEL ACCAD Source Type: blogs

A Vigilante in Statistical Badlands
This study, for instance, attributes a patient’s waitlist/transplant outcome to the very last dialysis facility the patient was associated with.  In epidemiology speak, this means the causal inference authors are trying to draw between for-profit status and good transplant outcomes is subject to time-varying confounding. As an example, if one is seeking an association between testosterone levels and risk of a heart attack, using the last testosterone level available would be a poor way of doing this study because testosterone levels are known to vary over time. The same applies to dialysis facilities. Patients chan...
Source: The Health Care Blog - May 25, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Eric Weinhandl JAMA medical research public health Public Policy public policy research Source Type: blogs

What do you think of this elderly man with " possible seizure " ?
Written by Pendell Meyers(with really great and thorough explanation of this finding by Ken Grauer).At my hospital, patients with any symptoms which could be vaguely interpreted as a possible stroke during the triage process are brought to the high acuity area and a provider is asked to do a " neuro check " , which involves a quick H and P and exam to determine if we should activate our stroke protocol.A man in his 70s was brought to me for a neuro check, and the triage providers commented that they were worried about a possible seizure as well. The patient was alert and oriented with normal vitals at triage. He stated tha...
Source: Dr. Smith's ECG Blog - May 23, 2020 Category: Cardiology Authors: Pendell Source Type: blogs

Burned out on Burnout?
Conclusion Learning how to pay attention to our attention (meta-attention) can be transformative. Using principles from cognitive science, we can create a comprehensive approach (attention capital theory in medicine) to reclaim the meaning and joy that has been depleted from our profession. Increasing the difficulty of our work to match our skill level, delegating low-level tasks to help us focus on critical steps in our physician zone, creating rules to eliminate distractions, and noticing both the wonder and suffering around us may be more important than resilience training or wellness modules. Although well-intention...
Source: The Health Care Blog - February 12, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Burnout physician burnout physician wellness Sanj Katyal Source Type: blogs

Low Value Testing and Unmet Cascades
By ANISH KOKA, MD Mr. Smith has a problem.  He can’t see.  Even this cardiologist knows why.  The not so subtle evidence lies in the cloudy lens in front of his pupils.  He is afflicted with cataracts that obstruct his vision to the point he can’t really do his job refurbishing antique furniture safely.  His other problem is that he hates doctors. He hasn’t had reason to see one for more than a decade.  He’s 68, takes no medications, smokes a pack of cigarettes a day, and is a master of one word answers. He’s in my office because he needs a medical evaluation prior to his cata...
Source: The Health Care Blog - January 21, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Patients Physicians Anish Koka cardiology low-value testing Source Type: blogs

2020 Mandrola Update
This study garnered the big stage at the Heart Rhythm Society meeting and its findings were published in two leading cardiac journals–JACC and Heart Rhythm. (We kept the spin to a minimum!) Being part of an RCT was almost as nifty as pacing the his bundle. That image is intoxicating. A cool thing about the time we live in is the ability to have mentors all over the world. Here, Dr. Andrew Foy and his team at Penn State University in Hershey PA, deserve mention. Andrew is a true academic; he has helped me understand research methods. We have published many papers together, including my favorite: The Case for B...
Source: Dr John M - January 3, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?
Conclusion of this paper: Fever is a great risk factor for arrhythmia events in Brugada Syndrome patients. Patients with known fever-triggered Brugada syndrome should be surveilled closely during fever and be started on antipyretic therapy as soon as possible.  There are limited data regarding the impact of EP study in BrS patients triggered by fever.  An EP study might be helpful in symptomatic patients (Sroubek et al., 2016) in the presence of spontaneous BrS ECG or drug-induced ECG.The prognostic significance of fever-induced Brugada syndrome.  Heart Rhythm 2016.Eighty-eight asymptomatic patient...
Source: Dr. Smith's ECG Blog - December 4, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

Confabulation of a cardiologist – post ISCHEMIA trial !
I have never found it difficult to retrogradely cross a dangerous epicardial collateral in complex CTO. Delivering a twin stent in a partial culotte strategy for a bifurc lesion has never tested my talents. Stenting a left main across the LAD, jailing the LCX with OCT support is my favorite time pass. Crushing a calcium infested diffuse long lesion with diamond-tipped ablator appear as breezy as shopping in a mall. But this one is really challenging  What is that? Understanding these four studies (Ref 1-4 ). They dogmatically say medical management confers definitive protection in chronic coronary syndromes. It stretches...
Source: Dr.S.Venkatesan MD - November 17, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome acc esc guidelines scai pci ptca stable chd courage bari 2d orbita ischemia trials tips and tricks in ptca Source Type: blogs

Forbidden tips in PTCA : OMG , give me strength to leave this lesion alone !
Confabulation of a confused cardiologist Yes, It has never bothered me to retrogradely cross a delicately dangerous epicardial collateral in complex CTO. Delivering a twin stent in a partial culotte strategy for a bifurc lesion has never tested my talents. Stenting a left main across the LAD, jailing the LCX with OCT support is my favorite time pass. Crushing a calcium infested diffuse long lesion with diamond-tipped ablator appear as breezy as shopping in a mall. Oh …I am terribly upset with this damn thing.  What is that? It requires 4 negative forces . . . to bring one big positive Impact! These studies say medic...
Source: Dr.S.Venkatesan MD - November 17, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome acc esc guidelines scai pci ptca stable chd courage bari 2d orbita ischemia trials tips and tricks in ptca Source Type: blogs