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 17, 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 sets ...
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 preventable “adverse dr...
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 conditions for which they are promoted.
T...
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 ?
One of the important determinant of...
Source: Dr.S.Venkatesan MD - February 9, 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 the bus a...
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, scient...
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 thr...
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
