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Total 177 results found since Jan 2013.

My Wheat Belly turning point
Many of you know that the Wheat Belly concepts got their start when I was trying to help patients in my cardiology practice obtain better control over risk for coronary disease. An exceptionally common combination of abnormalities in people with heart attacks, survivors of sudden cardiac death, those who have undergone stent implantation or bypass surgery, or have high coronary calcium scores (an early quantifier of coronary atherosclerotic plaque): large quantities of small LDL particles and high blood sugars (high fasting glucose and/or hemoglobin A1c, HbA1c, reflecting long-term blood sugar fluctuations). Because wheat...
Source: Wheat Belly Blog - June 11, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories cholesterol gluten grains lipids lipoproteins ulcerative colitis Weight Loss Source Type: blogs

Riociguat – Cardiology MCQ
Riociguat used in the treatment of pulmonary arterial hypertension is a: a) Phosphodiesterase 5 inhibitor b) Soluble guanylate cyclase stimulator c) Endothelin antagonist d) Calcium channel antagonist Correct answer: b) Soluble guanylate cyclase stimulator Riociguat is a novel drug for treatment of pulmonary arterial hypertension with a dual mode of action. It acts along with endogenous nitric oxide as well as by stimulating soluble guanylate cyclase by a mechanism independent of nitric oxide. It has been evaluated in PATENT-1 [1] and PATENT-2 [2] trials. References Ghofrani HA, Galiè N, Grimminger F, Grünig E, Humbert...
Source: Cardiophile MD - May 15, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Drug not to be combined with nitrates – Cardiology MCQ
Drug which should not be taken within 24 hours of nitrate intake and vice versa: a) Beta blocker b) Calcium channel blocker c) Alpha blocker d) Sildenafil Correct answer: d) Sildenafil Administration of nitrates by any route to those who have taken sildenafil during the past 24 hours can result severe hypotension. Any such inadvertent occurrences should be treated with fluid resucitation and alpha adrenergic agonists. In case of angina in a person who has taken sildenafil during the past 24 hours, antianginal agents other than nitrates have to be considered, to avoid this interaction. Sildenafil is a phosphodiesterase 5 in...
Source: Cardiophile MD - May 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Hypertension with angina – Cardiology MCQ
Drug of choice for hypertension in a person with coronary artery disease and angina pectoris: a) Alpha blocker b) Beta blocker c) Calcium channel blocker d) Angiotensin receptor blocker Correct answer: b) Beta blocker Beta blockers decrease myocardial oxygen demand and hence relieves angina pectoris. Both the negative inotropic and negative chronotropic effects of beta blockers contribute to this effect. This has led to the strong recommendation for beta blockers for management of hypertension in those with coronary artery disease and angina pectoris. Cardioselective beta blockers without intrinsic sympathomimetic activity...
Source: Cardiophile MD - May 9, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Can you explain the mechanism of heart muscle contraction?
Heart muscle contraction occurs due to the sliding in of actin and myosin myofilaments so that the length of the sarcomere (a unit of the muscle fibre) decreases. Sarcomere is the basic unit of the heart muscle and each muscle fibre has multiple sarcomeres. Excitation contraction coupling is mediated by release of calcium from the sarcolemma, when a stimulus transmitted through the Purkinje fibre depolarizes the muscle fibre.
Source: Cardiophile MD - April 29, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Just another intoxicated head injury
At the start of another busy weekend nightshift in a rural ED you receive a handover from the day team.A 31 year old female was brought in by police after an assault. Agitated, with a previous history of traumatic brain injury and intravenous drug use, the young lady is restrained and procedural sedation is required to perform the head CT scan.The sedation was challenging, as a result of Withnail levels of tolerance to benzodiazepines. Following 30mg IV Midazolam and two doses of Droperidol 10mg IM, and 10mg IV, the patient is still fighting and needs further sedation with Ketamine.Following confirmation of no intracranial...
Source: Life in the Fast Lane - April 27, 2015 Category: Emergency Medicine Authors: James Gaston Tags: Cardiology Clinical Case Education Toxicology and Toxinology droperidol TDP Torsades VT Source Type: blogs

Giant Inverted T waves in an Elderly Patient
This is another contribution from Victoria Stephen.  Victoria is a third year EM Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed.  Follow her on Twitter: @EMcardiac.Here is her previous contribution: Pulseless ventricular tachycardia – why did the AED not advise a shock?  CaseA 91 year old presented to the ED of a small hospital with a history of sudden onset syncope. A family member thought she was having a seizure. She reported no chest pain or dyspnoea when conscious. The patient had a history of hypertension which was poorl...
Source: Dr. Smith's ECG Blog - April 15, 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

Maleficent Troponins
We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.     All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convi...
Source: Spontaneous Circulation - February 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs

Causes of aortic stenosis
Brief Review Abstract: Causes of aortic stenosis include progressive degeneration and calcification of bicuspid aortic valve, degenerative calcific aortic stenosis, rheumatic aortic stenosis, familial hypercholesterolemia and ochronosis. In a study of about six hundred and fifty patients who underwent aortic replacement at Mayo Clinic, the most frequent causes of pure aortic stenosis were calcification of congenital bicuspid aortic valve, degenerative calcification of aortic valve and post inflammatory calcification and fibrosis of aortic valve thought to be of rheumatic origin. These three causes together contributed a...
Source: Cardiophile MD - January 15, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

What is myocardial hibernation?
Brief Review Abstract: Myocardial hibernation is reversible left ventricular dysfunction which occurs in a chronically ischemic myocardium, which improves after revascularization. Hibernating myocardium is a chronically ischemic myocardium, the function of which improves after successful revascularization. Short of revascularization, presence of hibernating myocardium can be documented by improvement in regional / global function of the left ventricular in response to nitrates, inotropes and postextrasystolic potentiation.1 Nitrates delivered sublingually or as an infusion during a wall motion study either by echocardiog...
Source: Cardiophile MD - December 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

The Wire
Nursing home staff became concerned about a patient because he was “floppy.” He was a 59-year-old man with stage 3 chronic kidney disease, right ventricular heart failure, hypertension, cirrhosis, and insulin-dependent type 2 diabetes mellitus. He had been sleeping all day, according to his nurse, but he was not responding when she checked on him in the evening, and she could “drop his arm and it would just hit his face.”   He was hypotensive (90/50 mm Hg) and bradycardic (about 30 beats/min) in the ED. Respirations were slow and shallow. He was protecting his airway, but was hypoxic (SpO2 82%). IV access was esta...
Source: Spontaneous Circulation - December 9, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs