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Heart failure in chronic kidney disease – Cardiology Basics
Heart failure in chronic kidney disease – Cardiology Basics Prevalence of both heart failure and chronic kidney disease (CKD) are increasing as the population is aging globally. Hence heart failure in chronic kidney disease is seen more often. Presence of CKD in heart failure increases morbidity and mortality. Though there is increasing use of effective medications and special devices like cardiac resynchronization therapy in heart failure patients in general, those with CKD have not been benefited well. CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for h...
Source: Cardiophile MD - October 21, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Intravenous acetazolamide for acute decompensated heart failure – ADVOR Study
Intravenous acetazolamide for acute decompensated heart failure – ADVOR Study Acetazolamide in Decompensated Heart Failure With Volume OveRload (ADVOR) study assessed whether intravenous acetazolamide can improve the efficacy of loop diuretics in acute decompensated heart failure with volume overload. Acetazolamide is a carbonic anhydrase inhibitor that reduces proximal tubular sodium reabsorption. It was a multicenter, double blind randomized, placebo controlled trial. Edema, pleural effusion and ascites were the important features of volume overload [1]. Ascites was confirmed by abdominal ultrasound and pleural eff...
Source: Cardiophile MD - September 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Is there Intracellular edema in congestive heart failure ?
I am unable to answer this question confidently even after spending 25 years in the specialty of cardiology. I thought, the answer was yes. Reality is definitely different. Such is the complexity in the biology of the fluid and circulatory systems. The heart’s function doesn’t seem to end with just pumping 6 liters of blood every minute, ultimately, it has to handle a huge load of water as well with delicate coordination with the kidney. (ANP,& RASS feedback). It is fascinating to note, that the heart transforms into a powerful endocrine organ as and when it is necessary. Read further, with a caution: (The...
Source: Dr.S.Venkatesan MD - May 31, 2022 Category: Cardiology Authors: dr s venkatesan Tags: cardiac failure edema in heart failure Source Type: blogs

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?
Submitted and written byDestiny Folk MD, peer reviewed by Meyers, Smith, Grauer, McLarenA man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. He reported difficulty walking and felt as if his left leg was “asleep.” He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he wa...
Source: Dr. Smith's ECG Blog - May 5, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Wireless Data Transfer for Implanted Devices Using Ionic Communication
Researchers at the Columbia University School of Engineering and Applied Science have developed a new method for implanted devices to communicate with the outside world that exploits the ions that are naturally present in our tissues. Ion-rich tissue...
Source: Medgadget - April 25, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Cardiology Diagnostics etc. Medicine Neurology Neurosurgery Pain Management Radiology columbia Source Type: blogs

An asymptomatic man in his 50s with heart rate in the 160s - what is the diagnosis? How will you manage this?
 Written by Pendell MeyersA man in his late 50s with history of CAD with CABG, COPD, smoking, cirrhosis, and other comorbidities presented for an outpatient scheduled stress test which had been ordered for some exertional shortness of breath, palpitations, and presyncopal episodes over the past few months. When he presented to the office for the stress test, his screening vitals before any test or intervention were remarkable only for a heart rate of 160 bpm. He denied any symptoms whatsoever.A 12-lead ECG was performed in the office:What do you think?The ECG shows a wide complex regular monomorphic tachycardia. I mea...
Source: Dr. Smith's ECG Blog - April 2, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life.
 Written by Pendell Meyers with edits by SmithA man in his 60s called EMS apparently for shortness of breath. EMS found him in distress and hypoxemic requiring 4 L nasal cannula to maintain oxygen saturation greater than 93%.Here is his triage ECG:What do you think?An old ECG was available on file, from 2 years ago:RBBB, otherwise normal.The triage ECG is diagnostic of life threatening hyperkalemia (sodium channel blockade would also produce this pattern, but the patient was not known to be on any sodium blocking medications). There is the very common brugada pattern STEMI mimic seen in V1 and partially in V3 and aVR....
Source: Dr. Smith's ECG Blog - January 16, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

A man in his 70s with chest pain, shortness of breath, and acute huge anterior ST elevation
Written by Pendell MeyersA man in his 70s presented to the ED complaining of various symptoms including chest pain and shortness of breath. He had a very hard time explaining his symptoms, and it was very hard to obtain an accurate history. It was unclear to us how long the patient had been experiencing symptoms, but I feel confident that he was actively having symptoms at the time of my evaluation. He did seem to admit to using cocaine, possibly yesterday evening, but unclear. His vitals were within normal limits except mild tachycardia.Here was his triage ECG:What do you think?I texted it to Dr. Smith with no information...
Source: Dr. Smith's ECG Blog - September 9, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

Wide and weird
Written by Clare Gunn MD, peer reviewed by Smith, Meyers, BraceyA 74-year-old female presented to the ER after a trip and fall (unclear if purely mechanical or due to possible unsteadiness) causing her to cut her leg. Due to chronic anticoagulation for atrial fibrillation, she could not stop the bleeding, so she came the ED.  On arrival she is found to be hypoxemic requiring four liters of oxygen via nasal cannula. While getting her leg wound repaired, the patient was also evaluated for hypoxemia and tachycardia and was found to have this ECG:What do you think?Here was her most recent prior ECG on file for comparison:...
Source: Dr. Smith's ECG Blog - August 27, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

Treatment of infective endocarditis
Discussion of whole list of options of antimicrobials for different varieties of endocarditis is quite a large topic. This discussion is only a broad outline of the antimicrobial treatment of infective endocarditis, meant mainly for exam purpose rather than actual clinical treatment. References to more detailed guidelines have been provided for those who wish to learn more. Inoculum Effect High microbial density as in vegetations cause less antimicrobial activity of some antimicrobial agents. This is known as inoculum effect and has been documented with β-lactams and glycopeptides but not linezolid, in the treatment of St...
Source: Cardiophile MD - July 16, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQs
Which of the following is NOT a drug used for metabolic modulation in heart failure? Trimetazidine Ranolazine Perhexiline Sacubitril-valsartan Correct answer: 4. Sacubitril-valsartan Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI). Trimetazidine is a 3-ketoacyl coenzyme A thiolase inhibitor, while ranolazine inhibits the late sodium current. Perhexiline inhibits carnitine palmitoyl transferase. Latter three are metabolic modulators while sacubitril-valsartan is a hemodynamic modulator in heart failure [Ashrafian H, Neubauer S. Metabolic modulation in heart failure: high time for a definitive ...
Source: Cardiophile MD - July 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance 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

Defining Hypertension : Why we remain in “ Status confusious ” despite 50 years of clinical trials ?
Next to the atmospheric pressure, the most curious pressure to understand is stored within human blood. Yes, it is the “blood pressure”, fondly referred to as BP by both physicians and patients. (When worried men & women visit us and say, that they are suffering from BP, please make it a point to clarify, BP is a sign of existence of life, rather than a dreaded pathology )  Why should blood have pressure? BP is lateral pressure exerted by flowing blood on the vessel wall (or is it the propelling pressure head ? It is to be noted, cuff pressure doesn’t measure this !) BP is generated by the heart in...
Source: Dr.S.Venkatesan MD - May 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Hypertension 2013 STEMI AHA ACC Guidelines blood pressure lowering treatment trialist collaboration hypertension and dyslipidemia Hypertension current guidelines jnc 6 7 8 hypertesnion Lancet BP LTT trial LDL vs diastolic BP vs fasting blood Source Type: blogs

Positron Emission Tomography (PET) in Cardiology
Positron emission tomography (PET) imaging is useful in assessment of myocardial perfusion and viability, atherosclerotic plaque activity as well as cardiac innervation in heart failure. PET is also useful in prosthetic valve endocarditis, endocarditis associated with cardiac implantable electronic devices (CIED), infiltrative cardiomyopathy, aortic stenosis and cardio oncology [1]. PET imaging has superior diagnostic accuracy compared to SPECT (Single Photon Emission Computed Tomography). It has improved spatial and temporal resolution and can measure regional blood flow and has less radiation. In PET, high energy gamma...
Source: Cardiophile MD - April 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Positron emission tomography Source Type: blogs