"there is lot of discussion about Sglt2inhibitors in forums, which has an edge Cana. or Dapaglifazone? "
Dear Diabetes spl,
It will be nice if you can clarify whether Cana.or Dapaglifazone is better. How? and. Why?share your experience and thoughts.
Dr Valluri Ramarao DNB (fam -med) (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 16, 2015 Category: Cardiology Authors: Dr valluri Source Type: forums
Mitral Valve Regurgitation
I am soon to be a 35 year old medical student and currently work for an NHS ambulance service as an Emergency Medical Technician.
At 15 years of age I was diagnosed with minimal mitral valve regurgitation which has remained asymptomatic since. I've had had repeat ECG's (the last in 2013) and always get told that it is within normal ranges.
Back in 2009 I was told that MVR is common and remains undiagnosed in a large proportion of the population. A figure for the amount of people who go undiagnosed was thrown in my direction, but I cannot remember what it was...does anyone know what that figure is?
Is Tris...
Source: Doc2Doc BMJ Cardiology - May 14, 2015 Category: Cardiology Authors: ph80 Source Type: forums
Appraisal and Revalidation
It's is that time of year again for me. Appraisal in June, and this will be my year for revalidation. I have retired as a partner after 35 years of inner City General Practice. But I still feel I have something to contribute and wish to do a few locums in General Practice for perhaps a couple of years.
The Appraisal and Revalidation system seem to grow year by year. It almost seems that the powers that be want GPs to take retirement and not go back to work. Is this a good idea, when waiting times to see GPs are so long?
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 13, 2015 Category: Cardiology Authors: Pat Lush Source Type: forums
Clinical question of the week: How would you treat this patient w palpitations, dyspnoea, dark stools?
A 75-year-old male with a prior history of hypertension, diabetes and treatment for “arrhythmia” presented to the emergency department complaining of palpitations and dyspnea on exertion over the last two days. The patient also reported dark stools over the last two days. No other symptoms were reported. Current medications included atenolol 50 mg qD, warfarin 5 mg qD, metformin 850 mg BiD.
The patient did not remember his last INR result, but reported no blood tests over the last two months. On examination the heart rate was 140, irregular, BP was 90/70, respiratory rate 22, SatO2: 94%. The patient ...
Source: Doc2Doc BMJ Cardiology - May 11, 2015 Category: Cardiology Authors: MBittencourt Source Type: forums
Clinical question of the week: "Arrhythmia" patient with palpitations, dyspnoea, and dark stools
A 75-year-old male with a prior history of hypertension, diabetes and treatment for “arrhythmia” presented to the emergency department complaining of palpitations and dyspnea on exertion over the last two days. The patient also reported dark stools over the last two days. No other symptoms were reported. Current medications included atenolol 50 mg qD, warfarin 5 mg qD, metformin 850 mg BiD.
The patient did not remember his last INR result, but reported no blood tests over the last two months. On examination the heart rate was 140, irregular, BP was 90/70, respiratory rate 22, SatO2: 94%. The patient ...
Source: Doc2Doc BMJ Cardiology - May 11, 2015 Category: Cardiology Authors: MBittencourt Source Type: forums
PC strikes again
So the WHO wants us to stop using geographical or personal names etc... to describe diseases as this could lead to discrimination. Note the worry - discrimination , not confusion. No more German measles , swine 'flu etc... No more Parkinson's. Just think of the interpretation by the public : Parkinson's disease eliminated. Ebola should go as it suggests a place of origin and might give Africa a bad name.
Some rational system for medical nomenclature should be in place , but surely some of this is PC going cuckoo ? Knowing how or where a disease originates may also be helpful in communication with the pu...
Source: Doc2Doc BMJ Cardiology - May 11, 2015 Category: Cardiology Authors: sken Source Type: forums
강남오피｡강서오피∧강남건마 BAMwar..COMペ｜밤｜｜워｜︽천안건마
강남오피｡강서오피∧강남건마 BAMwar..COMペ｜밤｜｜워｜︽천안건마 강남오피｡강서오피∧강남건마 BAMwar..COMペ｜밤｜｜워｜︽천안건마 강남오피｡강서오피∧강남건마 BAMwar..COMペ｜밤｜｜워｜︽...
Source: Doc2Doc BMJ Cardiology - May 3, 2015 Category: Cardiology Authors: abam1201 Source Type: forums
Clinical question of the week: Do novel oral anticoagulants (NOAC) need monitoring just like warfarin?
In the management of long term conditions, drug adherence and compliance remains an important problem. The cardiology community has responded positively to the introduction of novel oral anticoagulants (NOAC) as, in contrast to warfarin, NOAC obviates the need for regular monitoring. Is this too good to be true?
A study published in JAMA this week concluded that, among nonvalvular atrial fibrillation patients treated with NOAC, there is wide variability in patient medication adherence. Moreover, there is data to suggest that lower adherence with NOAC is associated with poorer outcomes and that warfarin style monitoring m...
Source: Doc2Doc BMJ Cardiology - April 20, 2015 Category: Cardiology Authors: Heart Matters Source Type: forums
Anatomical versus functional testing for coronary artery disease
In English nursery rhyme, it is traditional for a Duke to have 10 000 men. NEJM has published a trial from Duke University that recruited 10 000 men and women, and allowed in a further three for extra measure. These 10 003 recruits were those “whose physicians believed that nonurgent, noninvasive cardiovascular testing was necessary for the evaluation of suspected coronary artery disease.” That is a fate which befalls a staggering four million Americans every year. These people were randomised to be investigated either by coronary computed tomographic angiography or functional testing, which in almost ever...
Source: Doc2Doc BMJ Cardiology - April 8, 2015 Category: Cardiology Authors: Richard Lehman Source Type: forums
Clinical question of the week: ST elevation without obstructive coronary disease
A previously fit 42 year old woman developed severe chest pain after an argument with her partner. On arrival to A&E her ECG showed marked ST segment elevation in the septal leads. She was transferred for emergent coronary angiography but this demonstrated no obstructive coronary disease. Her chest pain and ecg changes resolved after a few hours with no q waves. and serum troponin was very elevated. Her ECHO showed severe LV impairment with anterior and inferior akinesia immediately after the coronary angiogram but normalised 2 days later.
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 7, 2015 Category: Cardiology Authors: heart doc Source Type: forums
Clinical question of the week
A previously fit 42 year old woman developed severe chest pain after an argument with her partner. On arrival to A&E her ECG showed marked ST segment elevation in the septal leads. She was transferred for emergent coronary angiography but this demonstrated no obstructive coronary disease. Her chest pain and ecg changes resolved after a few hours with no q waves. and serum troponin was very elevated. Her ECHO showed severe LV impairment with anterior and inferior akinesia immediately after the coronary angiogram but normalised 2 days later.
What is the most likely diagnosis ?
A) Takotsubo cardiomyopathy
B) Self limitin...
Source: Doc2Doc BMJ Cardiology - April 6, 2015 Category: Cardiology Authors: heart doc Source Type: forums
New Consensus Statement for Managing Hypertension in Patients with Coronary Artery Disease
By Larry Husten
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
The American Heart Association, American College of Cardiology, and American Society of Hypertension have issued an updated scientific statement on the treatment of hypertension in patients with existing coronary artery disease.
A key element of the statement is that it reinforces the blood pressure goal of less than 140/90 mm Hg in this population. However, for some patients who've had a previous cardiovascular event, a lower target of less than 130/80 mm Hg may be appropriate. The statement cautions against lowering bloo...
Source: Doc2Doc BMJ Cardiology - April 1, 2015 Category: Cardiology Authors: Mukhtar Ali Source Type: forums
Do you see more MIs when the clocks go forward?
British Summer Time (BST)/daylight saving time (DST) started in the UK over the weekend. DST started in the US on 8 March.
Open Heart research suggests there is a 24% transient increase in the incidence of acute MI in the week following this seasonal time change, and a 21% transient decrease in the week following the end of DST/the return to Greenwich Mean Time (GMT) in the autumn.
Do you notice these patterns where you work? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - March 30, 2015 Category: Cardiology Authors: Sabreena Source Type: forums
An end to the routine use of manual thrombectomy in STEMI?
Earlier this month the results of long awaited TOTAL trial were presented at the ACC meeting and simultaneously published in NEJM. TOTAL is the largest randomised trial to date which investigated the routine upfront manual thrombectomy with PCI alone in STEMI. 10,732 patients with STEMI undergoing primary PCI were randomised. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. Manual aspiration thrombectomy was associated with lower rates of incomple...
Source: Doc2Doc BMJ Cardiology - March 26, 2015 Category: Cardiology Authors: Heart Matters Source Type: forums
Statin intolerance: why do findings appear to differ so much?
Last year, the statins debate took some strange and personal turns in the UK. The issues were complex and entangled in unhelpful ways, but one fundamental question is that of statin intolerance: why do the findings of clinical trials and clinical experience appear to differ so much? The best way to determine the true prevalence of statin related muscle pains would be through a large series of n-of-one trials with complete blinding and adequate washout periods; but this is never going to be practical. The worst would be to depend on GP record entries and patient discontinuation. There are some in-between possibilities and I...
Source: Doc2Doc BMJ Cardiology - March 17, 2015 Category: Cardiology Authors: Richard Lehman Source Type: forums
