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

Why are you still taking a statin drug?
The post Why are you still taking a statin drug? appeared first on Dr. William Davis. (Source: Wheat Belly Blog)
Source: Wheat Belly Blog - September 4, 2020 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle alternatives to statins cholesterol coronary disease heart disease LDL lipids Lipitor undoctored Source Type: blogs

32 yo with right sided chest pain. Zero ST Elevation, but that does not matter.
DiscussionIn hindsight I feel there are very few alternative causes for an ECG like this other than an acute LAD occlusion. I believe this is one of those ' subtle STEMI ' cases where neither the ECG nor the symptoms are very obvious or severe and the usual evolution is not seen.I think of these cases as ' insidious infarcts ' and I have seen this in all infarct territories and I do not think they are particularly rare. Essentially the patient is fairly comfortable and the ECG is not obvious but the patient ended up with Q waves, huge troponins and we missed the opportunity to reperfuse the artery when it counts. These pat...
Source: Dr. Smith's ECG Blog - February 17, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

Beyond heart health: Could your statin help prevent liver cancer?
Liver cancer is hard to treat. It’s a top-five cause of cancer-related death worldwide and a growing cause of cancer-related deaths in the United States. Since liver cancer is often found at a late stage, when treatment has limited benefit, there has been increasing interest in prevention. That’s where statin medications might come in. Liver cancer is usually caused by chronic liver disease, so an important way to prevent liver cancer is to treat the underlying trigger. For example, curing hepatitis C infection — an important cause of chronic liver disease — reduces the risk of liver cancer. However, if the liver d...
Source: Harvard Health Blog - January 27, 2020 Category: Consumer Health News Authors: Irun Bhan, MD Tags: Cancer Drugs and Supplements Health Source Type: blogs

Are polypills and population-based treatment the next big things?
Cardiovascular disease (CVD), such as heart attack and stroke, is a leading cause of death and disability in the US. High blood pressure and high cholesterol are major risk factors for CVD, and even though they are quite common and highly treatable, they tend to be undertreated. This is especially true among those who are poor or members of a minority. It’s estimated that thousands of lives could be saved each year if more people with high blood pressure and high cholesterol received treatment for these conditions. The appeal of the polypill One reason that high blood pressure and high cholesterol are poorly treated is t...
Source: Harvard Health Blog - January 13, 2020 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Drugs and Supplements Health Heart Health Hypertension and Stroke Source Type: blogs

Study supports benefit of statin use for older adults
In this study, the most common reason that patients or their doctors stopped statins was the development of advanced cancer or other major illness. In my practice, I have also cared for many patients who have stopped taking statins or who express reluctance to take statins due to side effects. The most common side effect is muscle ache (typically tenderness or soreness of the large muscle groups, such as the biceps and thighs), which affects about 20% of statin takers and reverses when the statin is discontinued. There is also a slightly increased risk of diabetes with long-term statin use and, very rarely, liver problems....
Source: Harvard Health Blog - October 2, 2019 Category: Consumer Health News Authors: Dara K. Lee Lewis, MD Tags: Drugs and Supplements Health Healthy Aging Heart Health Source Type: blogs

Fight Aging! Newsletter, September 2nd 2019
In conclusion, in the absence of obesity, visceral adipose tissue possesses a pronounced anti-inflammatory phenotype during aging which is further enhanced by exercise. Methods of Inducing Cellular Damage are Rarely Relevant to Aging, and the Details Matter https://www.fightaging.org/archives/2019/08/methods-of-inducing-cellular-damage-are-rarely-relevant-to-aging-and-the-details-matter/ One of the major challenges in aging research is determining whether or not models of cellular or organismal damage and its consequences are in any way relevant to the natural processes of aging. One can hit a brick wit...
Source: Fight Aging! - September 1, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

A Large Polypill Clinical Trial Shows a Third Reduction in Cardiovascular Events
The research and medical communities are slow to undertake work on combination therapies. Regulation makes it exceedingly expensive to assess multiple combinations, and there are numerous other perverse incentives to challenge any effort to build combination therapies with components developed and manufactured by different groups. Short of working around the existing system of regulation, and methods of doing this at scale are lacking at the present time, this is a challenging problem to solve. People follow incentives. Given this, it it is entirely plausible that there are many largely unexplored instances in which existi...
Source: Fight Aging! - August 30, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs