Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
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 mode...
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 16, 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 for using MELD sc...
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
