GALACTIC-HF Trial: Omecamtiv mecarbil
GALACTIC-HF trial evaluated omecamtiv mecarbil, a cardiac myosin activator in heart failure with reduced ejection fraction [1]. The study had 8256 patients which included inpatients and outpatients with symptomatic heart failure with an ejection fraction of 35% or less. It was a placebo controlled trial of omecamtiv mecarbil in addition to standard heart failure therapy.
Primary outcome was a composite of first heart failure event or death from cardiovascular causes. Heart failure event was defined as hospitalization or urgent hospital visit for heart failure. Over a median follow up of 21.8 months, primary outcome event ...
Source: Cardiophile MD - June 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Fight Aging! Newsletter, May 24th 2021
In conclusion, we showed that addition of resistance exercise training, but not dietary EAAs, to the myostatin inhibition further increased muscle mass through the attenuation of muscle protein breakdown with proportionate improvements in muscle strength. Interestingly, addition of dietary EAAs to the myostatin inhibition with or without resistance exercise training improved muscle quality. Thus, dissection of the underlying mechanisms behind the combined positive effect of dietary EAAs and resistance exercise training on muscle mass and quality can shed light on the discovery of effective therapeutics against muscle wasti...
Source: Fight Aging! - May 23, 2021 Category: Research Authors: Reason Tags: Newsletters 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
Arguing for Raised O-GlcNAcylation to be Closer to the Cause of Heart Failure than Thought
Researchers here use animal models to argue that raised levels of O-GlcNAcylation observed in heart failure patients are more important than thought as a contributing cause to the progression of this condition, rather than being further downstream as an end consequence. One must always be careful, however, in analysis of work where researchers break some important mechanism, causing problems, and then fix it. It is always possible to produce harm by causing unnatural disarray to a specific mechanism in animal metabolism. Removing that unnatural disarray will always help. That doesn't mean that the model necessarily has rel...
Source: Fight Aging! - May 20, 2021 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Non-compaction of left ventricle
Non-compaction of left ventricle is often classified as a cardiomyopathy and is characterized by abnormal deep trabeculations, which is more at the apex [1]. Left ventricular non-compaction can be associated with left ventricular dilatation or hypertrophy. Systolic and diastolic dysfunction can occur and other congenital heart diseases can be associated. Ventricular arrhythmias and complete atrioventricular block can occur and present as syncope or sudden cardiac death.
Genetic transmission has been noted in 30-50% of patients and several genes have been implicated. NOTCH signaling pathway seems to be the final common pa...
Source: Cardiophile MD - April 23, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology 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
An 80-something with weakness, cough, and CP. Should this ECG provoke a Prehospital Cath Lab activation?
An 80-something called 911 for chest pain, generalized weakness, and cough.Here is his prehospital ECG:The medics were worried about this ECG and activated the cath labSmith: As in many prehospital ECGs with large voltage,the tracing goes off the image, making assessment of voltage impossible. Thus, it is impossible to assess the ST Segments and T-waves, which should always be assessed in proportion to the size of the QRS. I call this " proportionality " and in a non-ischemic ECG, the repolarization should always be proportional to the depolarization. Since we can ' t see the true size of t...
Source: Dr. Smith's ECG Blog - April 8, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Role of Valsalva maneuver in cardiology
The initial description of Valsalva maneuver was published by Antonio Maria Valsalva in 1704. It was forced expiratory effort against the closed glottis, nose and mouth, lasting for a few seconds. The maneuver was employed with the aim of expelling foreign bodies or exudates from the middle ear [1]. Even today otolaryngologists use variations of the maneuver very often. Edward Weber in 1851 detailed the cardiovascular changes associated with maneuver, making it useful for diagnostic purpose. Hence some authors prefer to call it as Valsalva-Weber maneuver [2].
The classical four phases of Valsalva maneuver and its hemodyn...
Source: Cardiophile MD - April 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Heart disease in pregnancy: Overview & management
Some of the questions addressed in this presentation
1.What happens to fetal blood pressure during maternal hypotension how good is fetal autoregulation?
2.Why is LSCS increasingly preferred mode of delivery in heart disease complicating pregnancy challenging the traditional scientific concept?
3.What is likely hood of patients with moderate mitral stenosis developing pulmonary edema during prolonged 2nd stage of labor?
3.What is the missing link between PIH and PPCM? How prepartum cardiomyopathy differs from postpartum?
4.Is Eisenemneger really an absolute contraindication for pregnancy?
5. How can we continue VKAs wa...
Source: Dr.S.Venkatesan MD - April 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Pregnancy and heart pregnancy and heart disease cardiac disease in pregnancy esc aha pregnancy heart disease fetal aortic blood Source Type: blogs
Left ventricular remodeling
Left ventricular remodeling occurs in response to left ventricular stress and injury. It is progressive and occurs after large myocardial infarctions and dilated cardiomyopathy. Left ventricular volume increases and the normal elliptical shape becomes globular. Left ventricular remodeling is associated with changes at microscopic level which include myocyte hypertrophy, apoptosis and increased interstitial collagen deposition [1]. Left ventricular remodeling is a central pathophysiological mechanism in advancing heart failure. Reversal of remodeling with treatment is an important goal in the management of heart failure. ...
Source: Cardiophile MD - April 2, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Nonspecific symptoms with RBBB and New ST Elevation. Anterior STEMI, right? What does the echo show?
A 50-something male with a history of COPD and substance use disorder who presented with generalized weakness and exacerbation of chronic back pain that is now radiating to his neck, and headache. He also developed nausea, alternating " hot and cold flashes " , and generalized weakness the previous evening. He became anxious about his symptoms and then used crack cocaine as well as drank alcohol last night. His symptoms have persisted since then. He states he has felt short of breath since last night. He denies any chest pain, though notes he has a " odd " sensation in his chest. Vital signs w...
Source: Dr. Smith's ECG Blog - March 28, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Does this ECG represent acute ischemia?
I was shown this ECG, without any clinical data:What do you think?My answer:" I think it is a baseline ECG, not ischemic. "Why did I say that? Because of the very high voltage. Whenever you see voltage like that, ST-T abnormalities which at first appear to be ischemic are probably simply secondary to the abnormal depolarization and due to LVH or some other baseline disease.And so it was indeed the patient ' s baseline ECG: The patient had presented for nonspecific symptoms and had the ECG recorded. So they searched for a previous ECG. Here it is from 20 months prior. Quit...
Source: Dr. Smith's ECG Blog - March 23, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
D-dimer levels in normal pregnancy : Learnt something Important recently !
Have we ever wondered how six liters of blood in our body flows like a live stream, maintaining the fluidity life long, in spite of an active coagulation system in situ, ready to freeze at the slightest provocation (Invisible vascular wear & tear!) This housekeeping job, within the vast network of the human vascular tree, is silently accomplished by a less apparent system called fibrinolytic system. D-dimer is a physiological breakdown product of this system . D-dimer comes from fibrin monomer. The D in D-dimer stands for the domain. (See below) The ability to detect the D-dimer in the bedside has given us a good oppor...
Source: Dr.S.Venkatesan MD - March 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease fdp vs d dimer pulmonary embolism dvt in pregnancy what is the normal d dimer in pregnancy Source Type: blogs
Annulus paradoxus and annulus reversus on tissue Doppler in constrictive pericarditis
Annulus paradoxus
The term “annulus paradoxus” was proposed by Ha JW et al to indicate the inverse correlation of E/E’ to pulmonary capillary wedge pressure (PCWP) on tissue Doppler evaluation in constrictive pericarditis. Usually a positive correlation is found in patients with primary myocardial disease between E/E’ and PCWP [1]. In their study of 10 patients, E’ was not elevated despite high left ventricular filling pressures. Hence E/E’ was low, with a mean 9 and it was <15 in 9 of their 10 patients.
Another study of 130 surgically confirmed patients with constrictive pericardit...
Source: Cardiophile MD - March 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
Phenocopies of hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is characterized by hypertrophy of the left ventricle, not related to load. It is a genetically transmitted condition. There are several mimickers of hypertrophic cardiomyopathy which can be called phenocopies of hypertrophic cardiomyopathy. Conventional form of HCM has been called sarcomeric HCM as it is due to mutations in genes encoding sarcomeric proteins [1].
Here is a small list of phenocopies of hypertrophic cardiomyopathy which is not truly exhaustive:
Fabry disease
Danon disease
PRKAG2 Cardiomyopathy
Pompe disease
Cardiac amyloidosis
Athlete’s heart
Hypertensive heart disease
...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Mimickers of HCM Mimickers of hypertrophic cardiomyopathy Mimics of HCM Mimics of hypertrophic cardiomyopathy Source Type: blogs
