A presentation on atrial fibrillation : Old wine in Old bottle
Caution: 2008 Presentation
This one is from the archive, a presentation on Atrial fibrillation done 14 years ago at KG.hospital, Coimbatore.
Link to PDF download
Good news: Nothing much has changed since 2008
Recognizing the clinical importance of AF and the need to rule out a systemic cause is the key, Further, a genuine bedside debate about the pros and cons of simple vs aggressive treatment discussion is welcome.
The nomenclature issue of valvular vs non-valvular has finally seemed to have settled. The latter is banished for good reason. (Funny to note Aortic valve was conside...
Source: Dr.S.Venkatesan MD - December 12, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation ACC AHA Atrial fibrillation affirm race af guidelines affirm trial atrial fibrillation Approach to atrial fibrillation a ppt presntation Source Type: blogs
Basics of hemodynamic evaluation – 2
Basics of hemodynamic evaluation – 2
Click here to see Part 1
This is the article in the series on basics of hemodynamic evaluation. As mentioned earlier, pressure measurement in each chamber is an important aspect of hemodynamic evaluation. Two types of catheter based pressure measurements are possible. One is using a catheter tipped manometer, which is more ideal, but expensive. Second, more commonly used method is using fluid filled systems with an external transducer. While using fluid filled systems, care has to be taken to avoid air bubbles in the connecting tubings to avoid damping of pressure wave transmissio...
Source: Cardiophile MD - December 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
A woman in her 60s with syncope and vomiting. Does she need a pacemaker?
Written by Pendell Meyers with some edits by Steve SmithA woman in her 60s on chemotherapy presented to the Emergency Department for a syncopal episode just prior to arrival. She was walking to the bathroom when she suddenly felt nauseous and passed out. EMS was called by the patient ' s daughter, and en route to the ED she vomited twice. On arrival to the ED, she adamantly denies chest pain but says she ' s " just still not feeling well. " She had no prior known cardiac disease.Triage at 0755:The rhythm is most either atrial fibrillation with complete heart block and resulting junctional escape, or atrial flutter wi...
Source: Dr. Smith's ECG Blog - November 19, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Is this ST depression due to OMI or due to subendocardial ischemia? This is critical to distinguish, and this is a trick case!
We just today published this very important article in the Journal of the American Heart Association:Ischemic ST ‐Segment Depression Maximal in V1–V4 (Versus V5–V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)full text: https://www.ahajournals.org/doi/pdf/10.1161/JAHA.121.022866However, if the patient has atrial fibrillation with RVR, one must first cardiovert and then re-assess. STD Max V1-V4 can be due to subendocardial ischemia (not OMI) when there is tachycardia, especially if due to atrial fibrillation with RVR.I have long noticed this (but have not f...
Source: Dr. Smith's ECG Blog - November 15, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Alcohol Ablation of Vein of Marshall for Persistent Atrial Fibrillation
Highly diagrammatic representation of coronary veins
Vein of Marshall (VOM) is a tributary of the coronary sinus with abundant sympathetic and parasympathetic innervation. It has been implicated in the genesis and maintenance of atrial fibrillation (AF). Three reasons described are the myocardial extensions into the structure, node like remnants within the vein and the rich autonomic innervation surrounding it [1] It is anatomically related to the mitral isthmus. Mitral isthmus is the region between the left inferior pulmonary vein ostium and the mitral annulus. Oblique vein of Marshall is the residua of the embryonic l...
Source: Cardiophile MD - November 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
PEA cardiac arrest, ROSC, and no STEMI on ECG. Randomized trials say emergent reperfusion is not indicated, right?
This study had a fatal flaw: they did not keep track of all the " Non-STEMI patients " who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients whom they suspected had Occlusion MI (OMI), even if they did not have STEMI. These physicians did not want a patient with an OMI that was not a STEMI to be randomized to no angiogram. This strong suspicion is supported by their data: only 22 o...
Source: Dr. Smith's ECG Blog - November 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Merck, GlaxoSmithKline, AbbVie, Sanofi & Bristol Myers Squibb: Big Pharma ’s Extending Digital Health Reaches
A few weeks ago, we kickstarted a new series of articles contemplating the moves of pharmaceutical heavyweights in the digital health arena. The first batch of companies, Johnson & Johnson, Pfizer, Bayer and Novartis, seem to have some interest in remote healthcare solutions and DTx.
In this second article, we will explore which trends pharma giants Merck, GlaxoSmithKline, AbbVie, Sanofi and Bristol Myers Squibb are eyeing.
Merck: big tech-friendly
A big pharma company itself, Germany’s Merck hasn’t shied from teaming up with big tech companies in recent years as it aims to make a lasting footpri...
Source: The Medical Futurist - October 26, 2021 Category: Information Technology Authors: Pranavsingh Dhunnoo Tags: Artificial Intelligence in Medicine Biotechnology Future of Medicine Future of Pharma Health Sensors & Trackers Personalized Medicine Portable Medical Diagnostics Security & Privacy pharmaceutics 23andme philips big pharma Merck Source Type: blogs
Acute Pulmonary Edema, PEA Arrest, LBBB, First degree AV Block, and STD maximal in V3, V4
An elderly woman had sudden SOB and 911 was called. Medics found her with labored breathing and 75% saturations. She was put on high flow oxygen. After placing her in the ambulance, she had a PEA arrest. She was intubated and ventilated, and given compression decompression CPR with theResQPod andResQPump.Aside:these 2 devices were invented by researcher Keith Lurie, who is in the Department of EM here at Hennepin; this isthe only method of CPR ever proven in a randomized trial to improve outcome in cardiac arrest see this ResQTrial, published in Lancet in 2011:Treatment of out-of-hospital cardi...
Source: Dr. Smith's ECG Blog - October 25, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Thinking like a plumber when adjusting medications
Recently, I solved a medical dilemma by changing the medication that seemed to have nothing to do with my patient ’s problem. Ethan Blake is a thin-boned, soft-spoken man with atrial fibrillation and a history of high blood pressure. He lives alone and prefers to shovel his own driveway. He also loves to walk his springerRead more …Thinking like a plumber when adjusting medications originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 24, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > Hans Duvefelt, MD < /a > < /span > Tags: Physician Cardiology Source Type: blogs
Paradoxical Low flow-Low gradient- Aortic stenosis: What is the paradox & why does it happen?
Aortic stenosis evaluation was so simple in our early days. Gradients across the valve were the key. Now, we have more parameters to bother about. Dynamic AVOs, flow state, resting LV function, contractile reserves, GLS, dobutamine response, etc. MRI assessment will soon overtake echocardiography.
Hemodynamics of flow across LVOT. MRI 4D volumetric model of normal Aortic stenotic flow in the bicuspid valve (On the left). The more we know, the more we tend to miss! Image courtesy: Northwestern Medicine
The current AS algorithms, though scientific, I am afraid, appear much complicated with some frightening terminol...
Source: Dr.S.Venkatesan MD - October 17, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases aortic stenosis amyloidosis in aortic stenosis ASE ACC AHA ESC guidelines for aortic stenosis dobutamine stress in aortic stenosis doppler error in aortic stenosis grading severity of aortic stenosis hypertension and aortic s Source Type: blogs
A 50s year old man with lightheadedness and bradycardia
Written by Pendell Meyers with edits by Smith and GrauerA man in his 50s with history of end stage renal disease on dialysis, prior bradycardia episode requiring transvenous pacemaker, diabetes, and hypertension, presented to the ED for evaluation of acute onset dizziness and lightheadedness starting several hours prior to arrival. These symptoms prevented him from going to dialysis, and his last session was three days ago. EMS found him with a heart rate of 30 bpm but normal blood pressure. He received 0.5 mg atropine with increased in heart rate to the 60s with improvement in symptoms. He denied chest pain or short...
Source: Dr. Smith's ECG Blog - October 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Big Pharma, Big Money: Johnson & Johnson, Pfizer, Bayer, Novartis in digital health
In a recent series of articles, we explored the latest moves of Tech Giants like Amazon, NVIDIA and Microsoft in the field of digital health. Analysing these recent developments can give us a better idea regarding where they are focusing the efforts, and how it might shape the future path of healthcare.
But equally, if not more, strong players in this field are pharmaceutical giants, as their resources and influence can significantly shape or alter the course of this path. As such, we are kickstarting a new series of articles focusing on the digital health efforts of 14 global pharma companies. While those heavywe...
Source: The Medical Futurist - October 12, 2021 Category: Information Technology Authors: Pranavsingh Dhunnoo Tags: Future of Medicine Future of Pharma digital health novartis pfizer J&J big pharma Johnson&Johnson Bayer Source Type: blogs
What is the Impact of Atrial fibrillation on blood pressure ? … It is also irregularly irregular !
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In severely dysfunctional ventricles this variation in systolic BP can be minimal. Also realize, If the preload is changing every beat, there is a considerable dynami...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs
What is the effect of Atrial fibrillation on blood pressure ?
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In dysfunctional ventricles or in acute AF* this variation in systolic BP can be significant. Also realize, If the preload is changing every beat, there is a consider...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs
Fight Aging! Newsletter, September 13th 2021
In this study, mature DCs (mDCs), generated from the GM-CSF and IL-4 induced bone marrow cells, were intravenously injected into wild-type mice. Three days later, assays showed that the mDCs were indeed able to return to the thymus. Homing DCs have been mainly reported to deplete thymocytes and induce tolerance. However, medullary TECs (mTECs) play a crucial role in inducing immune tolerance. Thus, we evaluated whether the mDCs homing into the thymus led to TECs depletion. We cocultured mDCs with mTEC1 cells and found that the mDCs induced the apoptosis and inhibited the proliferation of mTEC1 cells. These effects were onl...
Source: Fight Aging! - September 12, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
