Study Raises New Questions About Perioperative Beta Blockers
A large observational study finds that patients with hypertension who are taking beta blockers have higher rates of cardiovascular complications after noncardiac surgery. The study appears to support current guidelines against using beta blockers in the initial treatment of essential hypertension and may offer a contribution to the ongoing debate over the use of perioperative beta-blockade for noncardiac surgery...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - October 5, 2015 Category: Cardiology Authors: Larry Husten Tags: Policy & Ethics Prevention, Epidemiology & Outcomes beta blockers hypertension Source Type: blogs
Do cardiologists prescribe too many drugs?
One of the most common reasons people require medical care is their medical care.
This is a distinctly modern problem. In times past, doctors treated disease. Patients saw their doctor when they were sick. They had a problem; doctors offered help.
The doctor of today often improves health by removing healthcare. It’s one of my favorite tricks—stopping nonsense.
Excess healthcare happens for many reasons. Three big ones are the conflating of risk factors with disease, overdiagnosis and the one-disease-one-treatment mindset.
A high cholesterol level is not a disease but it is treated with a pill. When women acquire the d...
Source: Dr John M - September 20, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The Orange Juice Clue
The parents of a 16-month-old boy who presented to the ED were concerned that he was too sleepy. His initial point-of-care glucose was noted to be 42 mg/dL, and he was somnolent but arousable, and was given orange juice.
Twenty minutes later, the child’s symptoms had completely resolved. Toxicology was consulted for evaluation of a possible toxic ingestion, and a medication inventory was recommended.
Differential Diagnosis of Hypoglycemia in Children
n Ethanol intoxication
n Beta blocker intoxication
n Salicylate toxicity
n Sulfonylurea
n Insulin injection
n Endocrine disorder (hypopituitarism, Addison’s disease,...
Source: The Tox Cave - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Orange Juice Clue
The parents of a 16-month-old boy who presented to the ED were concerned that he was too sleepy. His initial point-of-care glucose was noted to be 42 mg/dL, and he was somnolent but arousable, and was given orange juice.
Twenty minutes later, the child’s symptoms had completely resolved. Toxicology was consulted for evaluation of a possible toxic ingestion, and a medication inventory was recommended.
Differential Diagnosis of Hypoglycemia in Children
n Ethanol intoxication
n Beta blocker intoxication
n Salicylate toxicity
n Sulfonylurea
n Insulin injection
n Endocrine disorder (hypopituitarism, Addison’...
Source: The Tox Cave - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
"How could I convince my interventionalist to come do a cath in the middle of the night?"
I just received this email today. I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients. I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center. They did not take him to the cath lab emergently. When he went to the cath lab t...
Source: Dr. Smith's ECG Blog - August 27, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
What is the secret of carvidilol’s superiority in CHF over other beta blockers ?
Beta blockers(BBs) have become key drugs in management of CHF .It helps by blocking toxic effects of inappropriately elevated catecholamine , which is actually a compensatory response(A fight and survival reaction ) from the sympathetic system to a failing heart . This process becomes a liability in the long run as the adrenergic receptors either down regulate or even promote apoptosis and cell death .Along with RASS-ACE it affects every cell in the body promoting neuro- humoral catabolic state.
By trial and error methodology we have found blocking the sympathetic system by BBs confer con...
Source: Dr.S.Venkatesan MD - July 31, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Beta Blocker beta blockers in chf carvidilol vs metoprolol and bisoprolol How carvidilol is superior in chf cardiac failure Source Type: blogs
Josee’s Dad succeeds at Wheat Belly with her coaching and cooking
Josee shared a wonderful story of how she helped her father succeed in following the Wheat Belly lifestyle, important to reduce/eliminate risk for coronary disease:
“I wanted to share my father Andre’s progress so far. He’s lost 36 lbs but he still wants to lose another 10 lbs. The ‘before’ picture was taken in July, 2014, but he started cutting carbs and grains in November, 2014. The ‘after’ picture was taken in July, 2015. He’ll be 76 years old in a couple of months and eating the Wheat Belly way has been rewarding in so many ways. He sleeps better, his mood is so much bett...
Source: Wheat Belly Blog - July 20, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories gluten grains heart disease Inflammation Weight Loss Source Type: blogs
Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management
A young woman presented with intermittent shocks from her implantable defibrillator. She was intermittently unconscious and unable to give history. The monitor showed intermittent polymorphic ventricular tachycardia. The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC. The PVC has an incredibly long QT, but the intervening native rhythms do not. However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was lo...
Source: Dr. Smith's ECG Blog - July 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Patient's Lie Masks the Cause of Chest Pain
A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.
While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspecifi...
Source: Spontaneous Circulation - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Patient's Lie Masks the Cause of Chest Pain
A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.
While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspeci...
Source: Spontaneous Circulation - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Blow your HDL through the roof
The HDL cholesterol value is one of the four values on any conventional lipid/cholesterol panel, along with total cholesterol, triglycerides, and calculated LDL cholesterol (what I call “fictitious” LDL because of its incredible inaccuracy when compared to superior measures).
The HDL cholesterol value has some unique characteristics not shared by the others, however, and can serve as an index of overall health. Very high HDL values, for instance, are associated with extreme longevity. Centenarians typically have values of 90 mg/dl or higher. Higher HDLs are also associated with less risk for diabetes, hypertens...
Source: Wheat Belly Blog - June 29, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle fish oil HDL longevity omega-3 saturated fat vitamin D Source Type: blogs
Transparency: Houdini’s last trick
By SAURABH JHA, MD
I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience – MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched for salt. I found neither.
I wondered what a speaker’s disclosure is supposed to trigger. Should we say “Stop, don’t advance your power point, until we regroup?” Demand that the statistics be re-run in front of us. Challenge, “You say p is 0.04. No, yo...
Source: The Health Care Blog - June 17, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs
How to teach clinical medicine – lessons learned by studying sore throats for 35 years
35 years ago I started collecting data in a non-acute emergency room. Over approximately 3 months the residents enrolled slightly more than 300 patients into the initial sore throat study. Spending the next 3 months learning how to analyze the data, I began a long journey that continues today.
Learning medicine rarely includes having epiphanies. Learning medicine requires patients and reading. But we who teach medicine can help our learners speed that process if we help them focus on some key features.
My colleagues and I often cite Judy Bowen’s classic article – Bowen, Judith L. “Educational strat...
Source: DB's Medical Rants - June 4, 2015 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Medical Rants Source Type: blogs
Research and Reviews in the Fastlane 086
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many institutions in the U.S. Stop the madness!
Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - June 3, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Administration Emergency Medicine R&R in the FASTLANE Resuscitation Wilderness Medicine critical care Education examination Intensive Care research and reviews Source Type: blogs
