No, we can ’ t call OMT, as a re-vascularisation procedure.
Hi, welcome Mr George, I just reviewed your records. You have three blocks in your arteries supplying the heart.
Are they serious Doctor ?
Not really, but one of them appear tight
What should I do Doctor ? But, I am comfortable Doctor.
You may be. But I am not .You need to undergo some re-vascularisation procedure .
What do you mean by that Doctor ?
It means either a percutaneous coronary intervention with a stent or CABG.
Can I get my heart re-vascularised by drugs alone Doctor ?
No we can’t . Hmmm , wait, we do have something called OMT/GDMT. Can you put on hold for some time Mr George, ...
Source: Dr.S.Venkatesan MD - February 25, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Acute chest pain in a patient with LVH and known coronary disease. What does the ECG show?
A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain.Here is his ED ECG:What do you think?There is a flat and downsloping ST segment in V2 and V3. This could be due to posterior OMI. Is there an old ECG for comparison?Here is the most recent previous ECG:Indeed, there was some normal ST elevation in V2 and V3, discordant to a relatively deep S-wave which could be due to some LVH.Here is another previous ECG:So it looks like a posterior OMI.2 years prior he had an angiogram which showed 90% proximal stenosis of the circumflex. It...
Source: Dr. Smith's ECG Blog - January 25, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, December 25th 2023
This study generates a comprehensive single-cell transcriptomic atlas of human atherosclerosis including 118,578 high-quality cells from atherosclerotic coronary and carotid arteries. By performing systematic benchmarking of integration methods, we mitigated data overcorrection while separating major cell lineages. Notably, we define cell subtypes that have not been previously identified from individual human atherosclerosis scRNA-seq studies.
Besides characterizing granular cell-type diversity and communication, we leverage this atlas to provide insights into smooth muscle cell (SMC) modulation. We integrate genome...
Source: Fight Aging! - December 24, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Modeling the Financials of a Drug to Treat Aging
We live in the world in which the regulatory costs imposed on the development of new medicine are enormous. This leads to centralization and regulatory capture. Only the largest entities, the Big Pharma companies, have the funds needed to satisfy the demands of regulators. These companies exist in synergy with the regulators, guiding the regulators (and the politicians backing them) to ensure that (a) their revenue streams are large and stable, and (b) there are fewer challenges to those revenue streams. Big Pharma entities are easily viewed through a cynical lens because their "treating the world, improving lives" rhetori...
Source: Fight Aging! - December 19, 2023 Category: Research Authors: Reason Tags: Longevity Industry Source Type: blogs
What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness. This originally radiated into her left arm. Over some time and the pain moved into her other arm as well as her jaw. She also had some shortness of breath. She was brought in by ambulance and re...
Source: Dr. Smith's ECG Blog - November 15, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Rosuvastatin or Atorvastatin , Which is good and safe ?
Statins belong to a group of drugs, stolen and reengineered from the blueprint of natural Chinese red yeast rice (Monocoline K) in the late 1980s. The rest is the remarkable history in the pharma industry.
Statins directly interrupt the cholesterol synthesis by blocking HMG-CoA within the hepatocytes. It significantly lowers the LDL, fights human vascular atherosclerosis. It makes the plaque either regress, prevent progress, make it harder and in the process make them less vulnerable . There are innumerable studies that document the evidence. Statin has become a must-prescribe drug in any one with clinically establishe...
Source: Dr.S.Venkatesan MD - November 10, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha atorvastatin vs rosuvastatin avert study bmj esc jamanetwork lancet lipid association lodestar study lodestar trial bmj nejm saturn trial simvastatin statins which statin superior Source Type: blogs
Generic Crestor Pricing Insanity
For a number of years, I ' ve used a statin drug (like 35 million Americans in the United States do). For more than a few years, these drugs were rather costly and protected by exclusive patent protection, although at the time, they were mostly covered by my insurance to prevent major heart attacks which could cost them even more (hundreds of thousands of dollars in claims).I ' ve used several different low-dose statins over the years, mostly for their preventative benefits. I initially began with Pfizer ' s Lipitor (atorvastatin calcium), but I experienced some pretty severe muscle aches which made it difficult for me to ...
Source: Scott's Web Log - August 23, 2022 Category: Endocrinology Tags: rosuvastatin calcium coupon-generating websites apps coupons Crestor generic generics PBM Source Type: blogs
A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
We Use Too Many Medications: Be Very Afraid of Interactions
By HANS DUVEFELT
I happened to read about the pharmacodynamics of parenteral versus oral furosemide when I came across a unique interaction between this commonest of diuretics and risperidone: Elderly dementia patients on risperidone have twice their expected mortality if also given furosemide. I knew that all atypical antipsychotics can double mortality in elderly dementia patients, but was unaware of the additional risperidone-furosemide risk. Epocrates only has a nonspecific warning to monitor blood pressure when prescribing both drugs.
This is only today’s example of an interaction I didn’t have at ...
Source: The Health Care Blog - October 21, 2021 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Physicians Primary Care Hans Duvefelt Medical Ethics medication pharmaceuticals Pharmacy Source Type: blogs
CORAL study on renal artery stenting
In the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study, 947 patients who had atherosclerotic renal artery stenosis and either systolic hypertension while taking two or more antihypertensive medications or chronic kidney disease were evaluated. It was a multi-center, open-label, randomized, controlled trial. Patients were randomized to either medical therapy plus renal artery stenting or medical therapy alone [1].
Previous randomized trials on renal angioplasty had failed to show significant benefit in control of blood pressure [2,3]. Another two randomized trials checking the effect of renal artery...
Source: Cardiophile MD - April 7, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Lowering cholesterol protects your heart and brain, regardless of your age
High or abnormal cholesterol levels, inflammation, and endothelial dysfunction play a key role in atherosclerosis and plaque buildup, the most common cause of heart attacks and strokes. (Endothelial dysfunction refers to impaired functioning of the inner lining of blood vessels on the heart’s surface. It results in these vessels inappropriately narrowing instead of widening, which limits blood flow.) There are many different types of cholesterol, including high density lipoprotein (HDL, or good, cholesterol); triglycerides (a byproduct of excess calories consumed, which are stored as fat); and low-density lipoprotein (LD...
Source: Harvard Health Blog - February 24, 2021 Category: Consumer Health News Authors: Hanna Gaggin, MD, MPH Tags: Drugs and Supplements Healthy Eating Heart Health Source Type: blogs
The Art of Explaining: Starting With the Big Idea
By HANS DUVEFELT
We live in a time of thirty second sound bytes, 280 character tweets and general information overload. Our society seems to have ADHD. There is fierce competition for people’s attention.
As doctors, we have so many messages we want to get across to our patients. How many seconds do we have before we lose their attention in our severely time curtailed and content regulated office visits?
I have found that it generally works better to make a stark, radical statement as an attention grabber and then qualifying it than to carefully describe a context from beginning to end.
Once a person shows...
Source: The Health Care Blog - January 29, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt health communication Source Type: blogs
Latest in lipidology: is lipoprotein(a), Lp(a), "the most dangerous particle you ’ve never heard of"?
Dr Attia's podcast on Lp(a), the link is here:https://peterattiamd.com/tomdayspring6/Discussed:- ApoB as a preferred metric over LDL-P [16:30]; Atherogenic lipoproteins (apoB/LDL-P) as front and center in pathogenesis of CVD. ApoB and LDL-P are used interchangeably, but this is not quite accurate.- Therapeutic goals for apoB concentration [21:45]-Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00];preferred lab measurements [1:17:45]; Lipoprotein(a), or Lp(a), is a distinctive particle with 2 components: - a lipoprotein core that resembles LDL- a shell that contains apolipopro...
Source: Clinical Cases and Images - Blog - October 16, 2020 Category: Universities & Medical Training Tags: Cardiology Source Type: blogs
Latest in lipidology: is lipoprotein(a) "the most dangerous particle you ’ve never heard of"?
Dr Attia's podcast on Lp(a), the link is here:https://peterattiamd.com/tomdayspring6/Discussed:- ApoB as a preferred metric over LDL-P [16:30]; Atherogenic lipoproteins (apoB/LDL-P) as front and center in pathogenesis of CVD. ApoB and LDL-P are used interchangeably, but this is not quite accurate.- Therapeutic goals for apoB concentration [21:45]-Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00];preferred lab measurements [1:17:45]; Lipoprotein(a), or Lp(a), is a distinctive particle with 2 components: - a lipoprotein core that resembles LDL- a shell that contains apolipopro...
Source: Clinical Cases and Images - Blog - October 1, 2020 Category: Universities & Medical Training Tags: Cardiology Source Type: blogs
