Part Two: Mastering Wrist Arthrocentesis
​We discussed the initial approach to the red, hot swollen wrist joint last month, and this month we focus on arthrocentesis of the joint with a full video of the procedure, including ultrasound and joint aspiration.A swollen, painful wrist that is hot to the touch with scant erythema is concerning for septic arthritis. The patient had multiple Band-Aids on his fingertips from blood glucose testing for diabetes, which increased his chances of having a septic joint with the punctures serving as an entry site for infection. Photo by Martha Roberts.The ProcedureIdentify the swollen joint, review the differential diagnosis, ...
Source: The Procedural Pause - May 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Benefit of DOAC over warfarin – Cardiology MCQ
Benefit of DOAC over warfarin – Cardiology MCQ Which of the following is NOT a known advantage of direct oral anticoagulant (DOAC) over warfarin? a) Reduction in stroke b) Lesser intracranial bleeds c) Lower gastrointestinal bleeding d) Lower mortality Post your answer as a comment below The post Benefit of DOAC over warfarin – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - April 17, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Left atrial appendage closure devices
Anticoagulation for prevention of stroke is a well established modality of treatment in atrial fibrillation. But a significant number of them have bleeding complications. Hence the option of left atrial appendage closure with multiple types of devices have been developed. Left atrial appendage with its sluggish flow is the most common location for thrombus formation in atrial fibrillation. Following devices have been used with varying success: Watchman Amplatzer Cardiac Plug/Amulet Lariat suture ligation Atriclip PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillatio...
Source: Cardiophile MD - April 15, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

SAMe-TT ₂R₂ score for poor INR control
SAMe-TT₂R₂ score for poor INR control SAMe-TT₂R₂ score aims at predicting those likely to have poor INR (International Normalized Ratio of Prothrombin Time) control while on vitamin K antagonists [1]. The investigators divided the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial cohort randomly into a derivation cohort and an internal validation cohort. They used linear regression analysis to find out the clinical parameters associated with time in therapeutic window (TTR) while on warfarin. Binary logistic regression analysis was used to evaluate the predictive performance of a ...
Source: Cardiophile MD - April 14, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Scores predicting bleeding risk in AF
Anticoagulation is vital for reducing the risk of stroke in atrial fibrillation (AF). There are several scores predicting bleeding risk in AF. These can be used to weigh between the need for anticoagulation and the risk of bleeding with it while taking an individualised decision. HAS-BLED: Hypertension, Abnormal liver or renal function, Stroke, Bleeding, Labile INRs, Elderly (>65 years), Drugs or Ethanol Abuse HEMORR2HAGES: (Hepatic or Renal Disease, Ethanol Abuse, Malignancy History, Older than age 75, Reduced platelet count or function, Rebleeding risk, Hypertension, Anemia, Genetic factors (CYP2C9 single nucleotide ...
Source: Cardiophile MD - April 14, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Part One: Tapping the Wrist
​The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for sep...
Source: The Procedural Pause - April 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

" Porch Pirates " and the Theft of Home-Delivered Drugs
In response to my recent note about the increasing competition between Amazon-PillPack and CVS in terms of home delivery of drugs, Andrea Pitkus submitted the following comment:It'll be interesting to see how this evolves, especially with the increase of porch pirates.It would be disastrous to patient safety if porch pirates steal meds from these unsecure delivery mechanisms. It would harm patients who need vital medication and also the receivers of the stolen (black market) meds. Hopefully, narcotics and other important meds are not delivered in the pill packs.Although"preset" pills are valuable for patients...
Source: Lab Soft News - December 27, 2019 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Healthcare Business Healthcare Innovations Medical Consumerism Pharmaceutical Industry Source Type: blogs

Cardiology MCQ – Warfarin for nonvalvular AF – Answer
Cardiology MCQ – Warfarin for nonvalvular AF – Answer Warfarin given in patients with nonvalvular atrial fibrillation (AF) can reduce ischemic stroke by — %: Correct Answer: 3. 60% A meta analysis of 29 trials including a total of 28,044 participants showed that warfarin reduced stroke by 64% while antiplatelet agents reduced stroke by 22% in those with nonvalvular atrial fibrillation. Absolute increase in major extracranial hemorrhages was 0.3% or lesser in this meta analysis. Back to question Reference Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients ...
Source: Cardiophile MD - December 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DOACs now recommended over warfarin to prevent blood clots in people with atrial fibrillation
For decades, warfarin (Coumadin) was the standard anticoagulant medication used to prevent blood clots, which can lead to stroke, in people with atrial fibrillation (afib). Direct oral anticoagulants (DOACs), sometimes called novel oral anticoagulants (NOACs), are a new type of anticoagulant medication that came on the market in 2010. In 2019, the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) updated their afib guidelines to strongly recommend using DOACs over warfarin in people with afib. Warfarin is effective, but has downsides Afib is a condition in which the upper chambers...
Source: Harvard Health Blog - December 16, 2019 Category: Consumer Health News Authors: Peter Zimetbaum, MD Tags: Drugs and Supplements Heart Health Source Type: blogs

Cardiology MCQ – Warfarin for nonvalvular AF
Cardiology MCQ – Warfarin for nonvalvular AF Warfarin given in patients with nonvalvular atrial fibrillation (AF) can reduce ischemic stroke by — %: 20% 40% 60% 80% Post your answer as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - December 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

MELD and MELD-XI scores
Model for End-Stage Liver Disease (MELD) score is a logarithmic function of creatinine, total bilirubin and International Hospitalized Ratio (INR): MELD = 9.57(logeCreatinine) + 3.78(logeBilirubin) + 11.21(logeINR) + 6.43. MELD score was originally developed to assess prognosis in patients undergoing transjugular intrahepatic portosystemic shunts (TIPS) for cirrhosis liver [1]. Later MELD score has been used in cardiovascular conditions like patients undergoing left ventricular assist device (LVAD) placement to operative transfusion requirements, morbidity, and mortality [2]. An important limitation f...
Source: Cardiophile MD - December 15, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Anticoagulation in pregnancy – Answer
Cardiology MCQ – Anticoagulation in pregnancy – Answer My Cardiology MCQ books on Amazon Best maternal outcomes in mechanical prosthetic valves with pregnancy is obtained with: Correct answer: 3. Warfarin Best maternal outcome in pregnancy with mechanical prosthetic valves is obtained with warfarin [1]. But it is a known teratogen and is associated with lowest number of live births. Low molecular weight heparin probably gives the best fetal outcome, though the maternal risk of thromboembolism is higher. Dabigatran is not recommended for mechanical prosthetic valves even without pregnancy. Generally warfarin is...
Source: Cardiophile MD - December 8, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Anticoagulation in pregnancy
Cardiology MCQ – Anticoagulation in pregnancy Best maternal outcomes in mechanical prosthetic valves with pregnancy is obtained with: Low molecular weight heparin Heparin Warfarin Dabigatran Click here for the answer with discussion (Source: Cardiophile MD)
Source: Cardiophile MD - December 8, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

The Future of Psychiatry: Telehealth, Chatbots, and Artificial Intelligence
Could a chatbot, an online community, or a telepsychiatry solution offer meaningful help for people who are fighting mental health issues? Could virtual reality, artificial intelligence, or genetics appear as elements of assistance in the toolkit of medical professionals in the fields dealing with the human psyche? While we agree that medical fields requiring the most empathy and human touch will most probably not be swept away by new innovations, we looked thoroughly at how technology will appear in the future of psychiatry. Perhaps even help heal the cursed prince from Beauty and the Beast? The human touch is indispen...
Source: The Medical Futurist - May 23, 2019 Category: Information Technology Authors: nora Tags: Future of Medicine Virtual Reality in Medicine AI apps AR artificial intelligence digital health digital health technologies health apps Innovation mental health psychiatry psychology technology VR Source Type: blogs

Still Negative on Watchman
Many readers have contacted me to ask whether my negative viewson left atrial appendage occlusion with Watchman have changed since 2017.   The short answer is no. My views are even more negative today.  In 2016, I published an editorial on theHeart.org | Medscape Cardiology arguing that this procedure should stop. One of the rebuttals was that it was a blog post, not an academic editorial. Months later, Andrew Foy, Gerald Naccarelli and I put the same argument into academic-speak and the influential journal Heart Rhythm published it.[1] I have debated and presented this topic multiple times ...
Source: Dr John M - May 18, 2019 Category: Cardiology Authors: Dr John Source Type: blogs

Healthcare In Estonia: Where Grandmas Go For Genetic Data
Imagine a country where citizens will have their genetic profiles integrated into the digital health system with individual risk scores and pharmacogenomic information, so when they go to the doctor, they will get fully personalized, genetic risk-based diagnosis, medication, and preventive measures. That’s where healthcare in Estonia will arrive soon. They started to build their digital health system 20 years ago, and within the next years, the Baltic country will start to reap the benefits of a transparent, blockchain-based, digital health system hooked on genetic data. The first fully digitized republic certainly s...
Source: The Medical Futurist - May 16, 2019 Category: Information Technology Authors: nora Tags: Future of Medicine Healthcare Policy analysis digital digital democracy digital health digital health strategy digital health system digital healthcare Estonia genetics genomics personalized Personalized medicine pharmacogenomi Source Type: blogs

No Quick Fix for the Culture of Prescribing that Drives Medication Overload
By THERESA BROWN, RN In my mid-twenties, I was twice prescribed the common antihistamine Benadryl for allergies. However, my body’s reaction to the drug was anything but common. Instead of my hives fading, they erupted all over my body and my arms filled with extra fluid until they were almost twice normal size. I subsequently described my experience to a new allergist, who dismissed it as “coincidence.” When I later became a nurse, I learned that seemingly “harmless” medications often cause harm, and older adults are particularly vulnerable. Every year, Americans over age 65 have preve...
Source: The Health Care Blog - April 25, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Patients Physicians overprescribing prescription medication Theresa Brown Source Type: blogs

Over-the-counter cold and flu medicines can affect your heart
As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants. NSAIDs and your heart Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhib...
Source: Harvard Health Blog - March 20, 2019 Category: Consumer Health News Authors: Mark Benson, MD, PhD Tags: Cold and Flu Drugs and Supplements Health Heart Health Source Type: blogs

Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic
Conclusion:  Incorrect computerized interpretation of atrial fibrillation, combined with the failure of the ordering physician to correct the erroneous interpretation, can result in the initiation of unnecessary, potentially harmful medical treatment as well as inappropriate use of medical resources. Greater efforts should be directed toward educating physicians about the electrocardiographic appearance of atrial dysrhythmias and in the recognition of confounding artifacts. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 21, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

What ’s in your supplements?
If you’re taking an over-the-counter supplement that wasn’t recommended by your doctor, you’re not alone — about half of the US adult population takes one or more supplements regularly. We spend more than $35 billion on these products each year. While it’s important that your doctor knows what you’re taking, there are many supplements out there, and it’s likely your doctor won’t know what advice to give you about a lot of them. There are a number of reasons for this but the two biggest are: Most supplements are not rigorously tested as a prevention or treatment for condition...
Source: Harvard Health Blog - February 15, 2019 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Vitamins and supplements Source Type: blogs

Critical gaps in STEMI knowledge base : What is the relationship between “ Time window ” and “ Age ” of IRA thrombus ?
Cardiologists are grappling with at least  half a dozen time windows  in the management of STEMI. (It can be combinations of any of the following :Symptom – DAPT Loading – Door – Needle /Balloon-Sheath, wire crossing etc ) Time windows are Important in choosing the right (or no)modality of re-perfusion . Though superiority of  primary PCI  is thought to be established in academic community , it  may not be in real world. Published studies that suggest pPCI is superior to lysis at any time window  still lack good evidence. Why is this long drawn confusion&n...
Source: Dr.S.Venkatesan MD - February 10, 2019 Category: Cardiology Authors: dr s venkatesan Tags: cath lab tips and tricks PCI PTCA Hardware Primary -PCI STEMI STEMI -Managment STEMI-Primary PCI Thrombolysis how to estimate the age of thrombus in stemi acs soft vs hard thrombus in stemi thrombus hardening time thrombus organising t Source Type: blogs

NOACs versus warfarin for secondary stroke prevention in atrial fibrillation
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - January 14, 2019 Category: Internal Medicine Tags: cardiovascular neurology pharmacology Source Type: blogs

The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing.  BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive):  ST Elevation in...
Source: Dr. Smith's ECG Blog - November 30, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Pharmacogenomics: The Science of Personalizing Drugs Based On DNA
Individuals share about 99.97 percent of their DNA and only the remaining 0.03 percent is responsible for the differences in skin, hair or eye color, height, shoe size or sunspots. Scientists discovered somewhat recently that our bodies also metabolize drugs differently so it would make sense to prescribe medications based on the knowledge hidden in our DNA. In some cases, physicians already do that. Here’s what you need to know about pharmacogenomics and the future of prescription drugs. It’s all in your genes Why do some people eat creamy French cakes all the time, only do sports when they have to run after t...
Source: The Medical Futurist - November 27, 2018 Category: Information Technology Authors: nora Tags: Future of Pharma Genomics Medical Professionals Patients Researchers DNA dna testing drugs genetics Health Healthcare Innovation medication pharmacogenetics pharmacogenomics precision health precision medicine technology Source Type: blogs

I Got My Whole Genome Sequenced. Here ’s What I Learned.
Dante Labs sent me their Full DNA whole genome sequencing package, and I went through a roller-coaster of feelings: I was excited to know every secret of my cells, but I was afraid to get to know my hereditary cancer risks and worried what I might find. As in my case, (scientific) curiosity usually overrides fear, I jumped into the unknown and I’m eager to share my results here. Whole genome sequencing is available to anyone. So what? The human genome is the blueprint for building a person. When the Human Genome Project was completed in 2006, and the DNA double spiral uncovered its secrets for the very first time, sc...
Source: The Medical Futurist - November 20, 2018 Category: Information Technology Authors: nora Tags: Biotechnology Genomics Medical Professionals Patients Personalized Medicine Policy Makers Dante Labs data DNA future genetic genome sequencing genomic data genomic testing Health health risks health science Healthcare I Source Type: blogs

23andMe ’s Pharmacogenetic Test Approved by FDA
The FDA has just approved 23andMe’s Personal Genomic Service (PGS) Pharmacogenetic Reports. This marks the first direct-to-consumer test for pharmacogenetics of enzyme variants that may affect the way patients break down medications. Consumers collect their saliva into 23andMe’s testing kit, mail it to the company’s labs, and then receive the results via an online portal. The approved pharmacogenetic assessment system looks for 33 variants of common enzymes that affect medication metabolism, including CYP2C19, CYP2C9, CYP3A5, UGT1A1, DPYD, TPMT, SLCO1B1, and CYP2D6. The full list of variants can be found ...
Source: Medgadget - November 1, 2018 Category: Medical Devices Authors: Ben Ouyang Tags: Diagnostics Genetics News Source Type: blogs

Anticoagulant nephropathy: is it unique to warfarin?
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - September 22, 2018 Category: Internal Medicine Tags: cardiovascular hematology nephrology pharmacology Source Type: blogs

Anticoagulation for prosthetic valve in pregnancy – Cardiology MCQ – Answer
Anticoagulation for prosthetic valve in pregnancy – Cardiology MCQ – Answer Anticoagulation regimen in pregnancy with prosthetic valve associated with lowest rate of fetal or neonatal loss: Correct answer: d) Low molecular weight heparin Low molecular weight heparin is associated with lowest rate of fetal or neonatal loss in pregnancy with prosthetic valve, but has a higher risk of valve thrombosis [1]. Though the often followed method is initial use of unfractionated heparin followed by warfarin in second trimester followed by unfractionated heparin in peripartum period, this approach has higher maternal...
Source: Cardiophile MD - September 16, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Uncategorized Source Type: blogs

Limitations of warfarin
Warfarin is very useful to prevent stroke in patients with atrial fibrillation and maintenance of function of a mechanical prosthetic valve. At the same time it has several limitations: Unpredictable response: Same dose produces different responses in terms of elevation of prothrombin time international normalized ratio (PT-INR) in different persons and in same person at different times. Narrow therapeutic window: Difference between toxic dose and ineffective dose is narrow. A mild increase in dose can produce a disproportionate rise in INR. Slow onset and offset of action: On the average it takes about 4 days for a stea...
Source: Cardiophile MD - September 15, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Uncategorized Source Type: blogs

Cannabidiol (CBD) — what we know and what we don’t
Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular? How is cannabidiol different from marijuana? CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it also is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CDB is a component of marijuana (one of hundreds), CBD by itself, does not cause a “high.” Accord...
Source: Harvard Health Blog - August 24, 2018 Category: Consumer Health News Authors: Peter Grinspoon, MD Tags: Drugs and Supplements Health Marijuana Source Type: blogs

MKSAP: 77-year-old woman with frequently fluctuating INRs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated for frequently fluctuating INRs (3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications. On physical examination, vital signs are normal, as is the remainder of the examination. Which of the following is the most appropriate next step in management? A. Daily low-d...
Source: Kevin, M.D. - Medical Weblog - August 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Oncology/Hematology Source Type: blogs

Changing the treatment plan when covering for another doctor
I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that. I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan when she was just covering for one day. As far as which is safer, warfarin with variable therapeutic effect and fluctuating INRs or novel anticoagulants, which have hardly been studied at all in patients on dialysis, you won’t see test result...
Source: Kevin, M.D. - Medical Weblog - August 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Cardiology Medications Source Type: blogs

Forskolin: another natural compound goes on my list of myeloma killers
Yesterday I came across a 2015 study that really caught my attention. A group of Norwegian researchers has discovered that the combination of dexamethasone with a natural compound called forskolin kills multiple myeloma cells. They tested forskolin with other conventional myeloma drugs, too: bortezomib (Velcade), cyclophosphamide, doxorubicin, and melphalan. And by itself. Results in a nutshell: dead myeloma cells.    Excerpt from the abstract: “Our findings support a potential role of forskolin in combination with current conventional agents in the treatment of MM.” The researchers believe that ...
Source: Margaret's Corner - August 1, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll forskolin myeloma Source Type: blogs

No Scientific Proof That Multivitamins Promote Heart Health
https://www.medscape.com/viewarticle/899130No Scientific Proof That Multivitamins Promote Heart HealthTaking multivitamin/mineral (MVM) supplements does not prevent myocardial infarction, stroke, or death from a cardiovascular cause, according to a comprehensive meta-analytic review of relevant research." The take-home message is simple: there is no scientific evidence that MVM supplements promote cardiovascular health. We hope that our paper helps to settle the controversy on MVM use for CVD prevention, " lead author Joonseok Kim, MD, University of Alabama at Birmingham, toldtheheart.org | Medscape Cardiology.Th...
Source: Dr Portnay - July 25, 2018 Category: Cardiology Authors: Dr Portnay Source Type: blogs

How dangerous are NSAIDs in patients with AF?
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban). My views on this matter have changed. But first, I want to mention a study published in JACC that addressed the issue of NSAID use in pts with AF who take an anticoagulant. This was a sub-analysis of the RELY trial, which pitted dabigatran vs warfarin. Remember, in the original RELY trial, the 150mg dose of dabigatran did better than warfarin at...
Source: Dr John M - July 13, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

‘Rats! I’m High’
​A 24-year-old man presented with uncontrollable epistaxis. He said he had been bleeding "a ton" from his nose continuously for four hours. He denied recent trauma, and explained that this epistaxis was sudden onset. He had no past medical history, and denied previous episodes of excessive bleeding. An examination demonstrated no signs of trauma and was unremarkable aside from the epistaxis. His nostrils revealed no obvious bleeding vessels for cauterization. His social history was remarkable for occasional drinking, marijuana use, and recent use of synthetic marijuana.His vital signs were a heart rate of 85 bp...
Source: The Tox Cave - July 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Evidence Crisis: Causal Inference – Don ’ t be a chicken (Part 3)
By ANISH KOKA Part 1 Part 2 Physicians have been making up numbers longer than people have been guessing weights at carnivals.  How much does this statin lower the chances of a heart attack? How long do I have to live if I don’t get the aortic valve surgery? In clinics across the land confident answers emerge from doctors in white coats.  Most of the answers are guesses based on whatever evidence about the matter exists applied to the patient sitting in the room.  The trouble is that the evidence base used to be the provenance of experts and anecdotes that have in the past concluded leeches were good f...
Source: The Health Care Blog - June 29, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs

Life as a doctor is selfless and selfish at the same time
It was 5:45 in the morning on a Monday after a full weekend of call. Thoroughly exhausted, I shuffled into the elevator and was met by the stench of stale clothing mixed with cigarette smoke. A painfully thin teenager exited, looking lost. I allowed him to wander out, grateful to be spared his odor. I was apathetic, overtaken by a weariness I vowed as a medical student never to have. Morning rounds passed without incident. All our CABG patients were more or less stable. I collected each patient’s overnight events, vital signs, laboratory values, daily chest X-ray, EKG, fluid balance and wound status. With my attendin...
Source: Kevin, M.D. - Medical Weblog - June 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/farah-karipineni" rel="tag" > Farah Karipineni, MD < /a > Tags: Physician Cardiology Hospital-Based Medicine Surgery Source Type: blogs

Roche Unveils Blood Coagulation Checker with Bluetooth Features
Roche has announced that next month it will be releasing a new device for patients to test their own blood coagulation parameters, the CoaguChek Vantus. The device, which looks like a cellular phone from a few years ago, has Bluetooth connectivity built-in, which lets it dump its INR readings to the patient’s smartphone and then automatically to the clinicians working with the patient. The idea was to reduce visits to the clinic while making things easier to keep track of for patients on warfarin. If setup and used correctly, the device alleviates any manual tracking of coagulation readings. “As healthcare...
Source: Medgadget - June 13, 2018 Category: Medical Devices Authors: Editors Tags: Cardiology Medicine Source Type: blogs

Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure
This is a middle-aged male with h/o with a history ofheart failure with severely reducedejection fraction due to dilated ischemic cardiomyopathy (EF 5-10%), probably with some component of non-ischemic cardiomyopathy, with h/o CABG, who is status post ICD placement (and previous appropriate shocks for VT) and biventricular pacer ( " cardiac resynchronization therapy " ), who is on amiodarone for VT suppression, and has h/o LV thrombus and is on chronicanticoagulation with warfarin.He presented forparoxysmal nocturnal dyspnea that didn't resolve with use of his home prn diuretics.  He...
Source: Dr. Smith's ECG Blog - June 9, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

A Tale of 2 FDAs
By ANISH KOKA Frances Oldham Kelsey by all accounts was not mean to have a consequential life.  She was born in Canada in 1914, at a time women were meant to be seen and not heard.  Nonetheless, an affinity for science eventually lead to a masters in pharmacology from the prestigious McGill University.  Her first real break came after she was accepted for PhD level work in the pharmacology lab of a professor at the University of Chicago.  An esteemed professor was starting a pharmacology lab and needed assistants, and the man from Canada seemed to have a perfect resume to fit.  That’s right, ...
Source: The Health Care Blog - June 4, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs

Antiphospholipid Syndrome
Antiphospholipid Syndrome (APS) important in vascular medicine as well as obstetrics. In obstetrics, it is important because it can cause fetal loss, intrauterine growth retardation and severe preeclampsia. In vascular medicine it is important because it can cause thrombotic events which could be arterial, venous or microvascular [1]. It can also be accompanied by moderate thrombocytopenia [2]. Thrombotic events involving multiple organs may be termed catastrophic Antiphospholipid Syndrome [3]. APS is an autoimmune disease with antibodies directed against beta2 glycoprotein I. This leads to suppression of tissue fact...
Source: Cardiophile MD - May 27, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology anti beta2 glycoprotein I antibodies anti cardiolipin antibodies lupus anticoagulant Source Type: blogs

Factors enhancing risk of limb loss after revascularization
are: Infra inguinal bypass using prosthetic material Bypass below the knee Use of sub optimal conduit Poor arterial runoff Extensive lesion When these risk factors are noted, anti thrombotic therapy can be intensified by adding either rivaroxaban or warfarin to aspirin. Another option is to give dual antiplatelet therapy. While intensifying therapy, risk of limb loss should be weighed against the potential bleeding risk in each individual. Triple therapy with two antiplatelet agents and one anticoagulant is better avoided in view of high bleeding risk. The post Factors enhancing risk of limb loss after revascularization...
Source: Cardiophile MD - May 26, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Peripheral Interventions Source Type: blogs

Prosthetic valve thrombosis with stroke – Cardiology MCQ
Treatment for prosthetic valve thrombosis presenting with stroke: a) Intravenous heparin b) Thrombolysis c) Surgery d) Warfarin Please post your answer as a comment below. Correct answer will be published on: May 25, 2018 @ 07:40 The post Prosthetic valve thrombosis with stroke – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 23, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Rivaroxaban versus warfarin and recurrent VTE
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - May 17, 2018 Category: Internal Medicine Tags: cardiovascular hematology pharmacology Source Type: blogs

Interview with Tal Golesworthy, Inventor of the ExoVasc Aortic Root Support
Tal Golesworthy is the inventor of the ExoVasc, a bespoke implant that supports the aortic root when it has becomes weak and dilated. Tal’s invention was born out of his personal need for the device to support his aorta that was expanding dangerously due to Marfan syndrome. In 2004, Tal was the first patient to be implanted with the device that he invented, and many more patients have benefited from the ExoVasc Aortic Root Support since. Medgadget editor Tom Peach spoke with Tal Golesworthy to hear about the inspiring journey that gave birth to the ExoVasc and to learn more about Exstent, the company that was formed ...
Source: Medgadget - April 10, 2018 Category: Medical Devices Authors: Tom Peach Tags: Cardiac Surgery Cardiology Exclusive Source Type: blogs

Which Direct-To-Consumer Genetic Test to Choose?
Due to the collapse of the price of genetic testing and the FDA’s gradual ease of the regulatory environment, direct-to-consumer (DTC) genetic testing companies are booming. You can inquire your deoxyribonucleic acid about your ancestry, health risks, metabolism, and some start-ups even promise you to find true love or your kids’ talents. As the jungle of DTC companies is getting denser, more and more people ask me which genetic tests are worth the try. They love the possibility of getting access to their DNA but don’t know where to start. Here’s the DTC genetic testing kick-starter package! Naviga...
Source: The Medical Futurist - March 20, 2018 Category: Information Technology Authors: nora Tags: Genomics 23andme ancestry DNA DTC future genetic test Genetic testing genetics Genome genome sequencing Health 2.0 Source Type: blogs

MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d). On physical examination, vital signs are normal. Cardiac auscultation demonstrates a normal mechanical S1. There are no murmurs or added sounds. Her INR is 2...
Source: Kevin, M.D. - Medical Weblog - February 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology OB/GYN Source Type: blogs

How to manage a patient with LA clot and Mitral stenosis ?
Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader')); Answer  Though PTMC in the presence of LA clot is an option in low risk clots , my strategy would be the last one ,whenever feasible. Intensive, monitored Heparin /Oral anticoagulants ( Heparin 5000 units tds or qid  or Low molecular weight heparin Enox...
Source: Dr.S.Venkatesan MD - February 3, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs