Perils of patient empowerment threaten to become a disease by itself !
Professional medical practice demands to put always the patient’s interest first. Unfortunately, current practicing methods threaten doctors to yield to patient’s whims & wishes which are influenced by significant non-academic forces. The principle of Informed consent is gradually losing its true meaning. Who is informing what ? and to whom? is becoming a hazy conundrum in complex two-way confabulation based on severely battered evidence-based medicine.
Some of the conversations not heard in silent corridors of big hospitals
Why did you stent his LAD ? , He had triple vessel disease Is’int CABG Ide...
Source: Dr.S.Venkatesan MD - March 5, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Higher Quality Healthcare Correlates with Lower Blood Transfusion Rates
In a previous life in the 1970s, I was a blood banker at a large academic hospital. This may sound unbelievable to some of the currentLab Soft News readers but one of our cardiac surgeons in the 1970's would often transfuse six or more units of blood during a CABG (see: Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery). Although modern blood transfusion can be life-saving, it can sometimes be a substitute for controlling hemorrhage by other and more appropriate means. In other words, less transfusion can often be equated with higher quality care. There is also a financial benefit when a hos...
Source: Lab Soft News - December 10, 2019 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Blood banking Clinical Lab Industry News Cost of Healthcare Lab Industry Trends Medical Research Quality of Care Source Type: blogs
A young peripartum woman with Chest Pain
This is written by Brooks Walsh.https://twitter.com/BrooksWalshA 30 year-old woman was brought to the ED with chest pain.It had started just after nursing her newborn, about an hour prior, and she described it as a severe non-pleuritic “pressure” radiating to the back.She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying " I ' m just an anxious person. "A CXR and a CTA for PE were normal.The ECGsAn initial ECG was obtained as the pain was rapidly resolving:Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and&nbs...
Source: Dr. Smith's ECG Blog - October 23, 2019 Category: Cardiology Authors: Brooks Walsh Source Type: blogs
How are hospitals supposed to reduce readmissions? Part II
By KIP SULLIVAN, JD
The
notion that hospitals can reduce readmissions, and that punishing them for
“excess” readmissions will get them to do that, became conventional wisdom
during the 2000s on the basis of very little evidence. The Medicare Payment
Advisory Commission (MedPAC) urged Congress to enact the Hospital Readmissions
Reduction Program (HRRP) beginning in 2007, and in 2010 Congress did so. State
Medicaid programs and private insurers quickly adopted similar programs.
The rapid adoption of readmission-penalty programs without evidence confirming they can work has created widespread concern that these prog...
Source: The Health Care Blog - October 1, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy CMS hospital readmissions Hospital Readmissions Reduction Program HRRP Kip Sullivan MedPAC Source Type: blogs
Ischemic cardiomyopathy: Why is it, still searching for a definition?
The term Ischemic cardiomyopathy(ICM) was originally coined by Dr. Burch from Tulane University, New Orleans, USA in 1970. For many decades there was skepticism regarding the existence of such entity. WHO classification over the years never included this term. ESC working group of 2008 (Elliott P, European Heart 29(2):270–276) decided not to include CAD as a cause for cardiomyopathy. Even the current MOGES system doesn’t invoke CAD as a cause for cardiomyopathy. But, I am sure, most of practicing cardiologists would agree, there is a need for such an entity.
Why there is much reluctance to diagnose Ische...
Source: Dr.S.Venkatesan MD - September 21, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Criteria and Nomenclature ischemic cardiomyopathy Uncategorized defintion of ischemic cardiomyopathy MOGES classification what is ischemic cardiomyopathy who whf classification of cardiomyopathy Source Type: blogs
Machine Learning Helps Predict Risk of Heart Failure in Patients with Diabetes
Researchers from Brigham and Women’s Hospital and UT Southwestern Medical center have developed a new machine learning algorithm that predicts the risk of heart failure hospitalization for people suffering from type 2 diabetes. Their work demonstrates that among 147 different demographic, clinical, and biological data, there is an important top 10 list of predictors, which includes BMI, age, hypertentsion, creatinine, HDL-C, and QRS duration.
One day, insightful algorithms such as these will hopefully be integrated into electronic health record systems, allowing physicians to identify risk factors for individual patie...
Source: Medgadget - September 19, 2019 Category: Medical Devices Authors: Siavash Parkhideh Tags: Cardiology Informatics Medicine Source Type: blogs
Totally endoscopic coronary artery bypass grafting (TECAB)
Totally endoscopic coronary artery bypass grafting (TECAB) is done with precision using robotic surgery equipment [1]. Unlike conventional coronary artery bypass grafting (CABG) which is done through a midline sternotomy, TECAB is done through four to five small ports with the help of the da Vinci Surgical System. The da Vinci robotic system is a highly advanced tool which helps the surgeon sitting in the equipment console to control the robotic surgery arms. Tiny video cameras attached to robotic arm give a detailed three dimensional view of the operating field inside the thoracic cavity. Robotic endostabilizer is avai...
Source: Cardiophile MD - September 8, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs
Localising “ Angina related artery ” ( ARA ) in UA/NSTEMI : Can we differentiate culprit artery from lesion ?
Identifying the culprit after a criminal event may be easy for the police.For cadiologists investigating the crime scne after a coronary event, It is a different story. (Of course, localization of IRA after a STEMI may not be really difficult.) But , when a patient is having UA and coronary artery shows multiple lesions, we do have real diagnostic issue. The general dictum could be tightest lesion or complex eccentric lesions with thrombus is likely to be the culprit. This has important therapeutic Impication as we are argued to address the active lesions first. The following study was done in 2009 trying to address ...
Source: Dr.S.Venkatesan MD - August 11, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
How does acute left main occlusion present on the ECG?
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. In these ...
Source: Dr. Smith's ECG Blog - August 8, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Understanding Ischemic mitral regurgitation
The mechanism of MR in ischemic /Functional is complex. Technically, pure ischemic MR should have a structurally normal leaflet and the subvalvular mechanism dominates But,the combination of the two is also prevalent. In fact, a degenerative component is added to this in many elderly patients.
Mechanism of Ischemic mitral regurgitation
Any of the following may contribute either alone or in in different combinations.
Global LV dilatation with or without annular dilatation
Spherical left ventricle
Altered inter papillary muscle distance (Degree and direction of posterior vs apical displacement of pap muscle)
Chordal short...
Source: Dr.S.Venkatesan MD - July 16, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Mitral annulus -Functional mitral regurgitation ischemic functional mitral regurgitation mitraclip mitral valve tethering neo chordae implantation papillary muscle papillary muscle dysfunction secondory mitral regurgitation valve in valve Source Type: blogs
Understanding Ischemic mitral regurgitation … think of a tethered cow that ’ s randomly grazing !
The mechanism of MR in ischemic /Functional is complex. Technically, pure ischemic MR should have a structurally normal leaflet and the subvalvular mechanism dominates But,the combination of the two is also prevalent. In fact, a degenerative component is added to this in many elderly patients.
Mechanism of Ischemic mitral regurgitation
Any of the following may contribute either alone or in in different combinations.
Global LV dilatation with or without annular dilatation
Spherical left ventricle
Altered inter papillary muscle distance (Degree and direction of posterior vs apical displacement of pap muscle)
Chordal short...
Source: Dr.S.Venkatesan MD - July 16, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Mitral annulus -Functional mitral regurgitation ischemic functional mitral regurgitation mitraclip mitral valve tethering neo chordae implantation papillary muscle papillary muscle dysfunction secondory mitral regurgitation valve in valve Source Type: blogs
Fight Aging! Newsletter, June 24th 2019
This study sought to investigate what could be learned from how these men have fared. The men were born in 1925-1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age.
Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, ...
Source: Fight Aging! - June 23, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Progression of Atherosclerosis is Slowed in Mice via Targeting Senescent Cells
We reported that plasma levels of angptl2 are elevated in patients with cardiovascular diseases (CVD), were associated with endothelial dysfunction, and were predictive of major cardiac adverse events and death. Recently, we reported a strong relationship between arterial expression of p21, a cell cycle inhibitor overexpressed in senescent cells and maintaining growth arrest, and circulating levels of angptl2 in atherosclerotic patients. Senescent EC are activated and promote aggregation of leukocytes, the initiating step of atherogenesis. We therefore hypothesized that down-regulation of vascular angptl2, preferentially i...
Source: Fight Aging! - June 18, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Ultrasound Case 094
Dr James Rippey Ultrasound Case 094
A 68 year old male presents 2 weeks post coronary artery bypass grafting. He describes continuing chest wall pain, increasing shortness of breath and poor exercise tolerance. You wonder whether this is a pericardial effusion have a look. (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - May 29, 2019 Category: Emergency Medicine Authors: Dr James Rippey Tags: Cardiology TOP 100 Ultrasound echocardiography Pericardial effusion Post CABG Effusion spine sign Top 100 ultrasounds Source Type: blogs
What happens when you don't recognize an OMI?
This was sent by an " avid reader. " The case was from his hospital, which does not have a cath lab. He was very frustrated by the care the patient received from his partner, and the absence of an appropriate openness to learning by those in his department.CaseA 60-something male was sent in from a cardiologists ' office after presenting there with chest pain. The office ECG is unavailable.The pain had been intermittent for a few days, but worse on the day of admission.Here was the initial ECG:To me, and to him, this is an obvious acute LAD occlusion.There are hyperacute T-waves, especially in V2, plus ot...
Source: Dr. Smith's ECG Blog - May 6, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
