Bacterial endocarditis (Endocarditis) - High Yeild Topics For USMLE, 10 Points You Should Know
is a localized infection of the endocardium
characterized by vegetations involving the valve leaflets or walls.
It can also be classified as acute (ABE) or subacute (SBE).
Infection of healthy valves by high-virulence organisms
Produces metastatic foci
Usually fatal if not treated within 6 weeks
Most common organism is S. aureus (MCQ)
Seeding of previously damaged valves (rheumatic heart disease, con-
genital valve defects: mitral valve prolapse)
caused by low-virulence organisms
Does not produce metastatic foci
Most common organism is Streptococcus viridans (MCQ)
Mitral valve is most often affec...
Source: Doc2Doc BMJ Cardiology - November 24, 2014 Category: Cardiology Authors: drmurali Source Type: forums
Thoughts on IE prophylaxis?
Although limited, recent evidence suggests the new NICE guidelines might have been a step back, not forward, on IE prophylaxis. Should the guideline be updated backwards based on new evidence?
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 21, 2014 Category: Cardiology Authors: MBittencourt Source Type: forums
Cardiovascular risk, will ezetimibe IMPROVE-IT?
After quite a long time on the market, the first evidence supporting the use of ezetimibe to reduce CV events became available. The IMPROVE-IT study followed a very large cohort of very high-risk individuals for a very long time to demonstrate a small, yet significant, reduction and a composite CV outcome.
I am not particularly impressed, and would probably only use it for a restricted number of patients, but I am rather curious on how others see the data.
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 21, 2014 Category: Cardiology Authors: MBittencourt Source Type: forums
Dual anti-platelet therapy after DES, how long should it be?
The benefit of aditional antiplatelet therapy (clopidogrel, prasugrel or ticagrelor) of DES is well documented. However, due to the increased bleeding, controvesy remains on the ideal duration of therapy. I have mostly recommended one year dual antiplatelet therapy.
4 trials presented at AHA yesterday have conflicting results. While DAPT suggests 30 months is better than 12, two european studies ISAR-SAFE and ITALIC support that 6 months is not different than longer treatments.
What do you usually do? 6, 12 or even more? Individualize? How? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 18, 2014 Category: Cardiology Authors: MBittencourt Source Type: forums
What is the future of "Triple Therapy" after coronary stenting?
Identifying the optimal regimen for antiplatelet therapy in patients requiring long-term anticoagulation following coronary stenting is an area that has traditionally been understudied. Although all major guidelines recommend (limited) triple therapy in this situation, these recommendations are either result of expert consensus or are largely based on observational data.
The WOEST trial was an open-labelled randomised trial and compared dual therapy (a combination of clopidogrel and vitamin K antagonist) with triple therapy (Aspirin, clopidogrel and vitamin K antagonist) in patients undergoing coronary stent...
Source: Doc2Doc BMJ Cardiology - November 17, 2014 Category: Cardiology Authors: Heart Matters Source Type: forums
POISE-2Trial and Pre operative care guidelines
What should be the pre operative prescription, if any, to reduce CV events close to surgery in high risk patients?
Recent recommendations say:
Continue beta-blockers, ASA and statins if in use. Do not start if not in use.
In short, mostly keep doing your regular stuff, nothing else for most cases. Then, what should be the role of a GP, internist or cardiologist in the routine pre-op care? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 13, 2014 Category: Cardiology Authors: MBittencourt Source Type: forums
Diagnostic and therapeutic dilemma
62 year old Caucasian woman with a history of diabetes on oral hypoglycemics,active smoker; hospitalized in the recent past for congestive heart failure came in with pulseless electrical activity(PEA) arrest.Ejection fraction (EF) on recent echo done 1 week prior was 65% with mildinferolateral wall hypokinesis. She is admitted this time with respiratory failure leading to intubation in the field, followed by PEA arrest on arrival in the emergency. Resuscitated after 4-5 minutes of cardio-pulmonary resuscitation-no purposeful movements noted, but patient opens eyes spontaneously.Electrocardiogram after resuscitation a...
Source: Doc2Doc BMJ Cardiology - November 11, 2014 Category: Cardiology Authors: Heartfelt Source Type: forums
Exam question - which is the correct answer?
The question below is taken from the BMJ's OnExamination revision questions for the MRCGP exam. I'll post the answer in a few days.
A 58 year old woman is referred to you from the practice nurse after electrocardiography shows she is in atrial fibrillation.
When you take her history she complains of palpitations and that she has also noticed some weight loss over the past two months. On examination, she has an irregularly irregular pulse and displays a fine tremor.
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 10, 2014 Category: Cardiology Authors: AnneG Source Type: forums
Interesting clinical case...what's the cause?
This is an actual clinical case that attended my hospital.
A 40 year old Afro - American man who's usually fit and well suddenly presents with syncope and is found to be in complete heart block. Echo shows structurally normal heart. He is treated with a pacemaker.
All is well until 2 years later when he suddenly complains of palpitations and shortness of breath. On arrival to the emergency department he is in sustained monomorphic ventricular tachycardia and is quickly DC cardioverted as haemodynamically compromised. His recovery ECG shows sinus rhythm with ventricular pacing. He has another echo which now shows severel...
Source: Doc2Doc BMJ Cardiology - November 2, 2014 Category: Cardiology Authors: heart doc Source Type: forums
Vitamin D Might Help Kids With Eczema
Daily vitamin D supplements might help children with eczema that gets worse in the winter, a new study suggests.
http://www.nlm.nih.gov/medlineplus/news/fullstory_148978.html (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - October 20, 2014 Category: Cardiology Authors: Mukhtar Ali Source Type: forums
New cardiology clinical champions
Doc2doc is sad to say goodbye to our cardiology clinical champion Sadian, who has decided to step down after providing sterling service on the message boards over the last few years. Hopefully Sadian will still visit doc2doc from time to time.
However, we're very excited to welcome four (yes four!) replacements who have a great breadth and range of experience.
I'm introducing them with their screen names so you know who they are online:
Mbittencourt, a cardiologist based in Brazil who has particular interest in CT;
Heart Matters, a trainee cardiologist from the West Midlands in th...
Source: Doc2Doc BMJ Cardiology - October 20, 2014 Category: Cardiology Authors: AnneG Source Type: forums
Reoriented embolus
What is the course of a reoriented embolus in the arterial circulation ? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - September 27, 2014 Category: Cardiology Authors: rop Source Type: forums
PVC and PAC
Hi all,
Is there a value that says how many PVC and PAC in an hour is consider risk for a normal patient.
I found these values from some of the papers I've read, but I would like second opinon.
PVC: in a hour of ECG report
No risk: <60PVC/hr
Risk 60-120PVC/hr
High Risk: >120PVC/hr
PAC: in a hour of ECG report
No risk: <80 pac
Risk: 900-1200 pac
High Risk: >1200 pac
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - September 26, 2014 Category: Cardiology Authors: JackC Source Type: forums
Should patients in cardiac arrest be taken to hospital?
A head to head debate on the BMJ looks at whether patients in cardiac arrest should be taken to hospital.
Jonathan Benger argues no, just 10% of people who have a cardiac arrest outside of hospital survive to discharge from hospital. Hospital has nothing to offer the 60,000 people who cardiac arrest outside hospital, he argues, and the journey to hospital can actually be harmful.
"Preparing patients for transport, moving them, and driving them to hospital lead to pauses in CPR [cardio-pulmonary resuscitation] and suboptimal chest compressions even with the most skilled and committed staff." Paramedics are the exp...
Source: Doc2Doc BMJ Cardiology - September 24, 2014 Category: Cardiology Authors: AnneG Source Type: forums
echo in africa
The British society of echocardiography are launching a programme to undertake screening for rheumatic valve disease amongst secondary school age children. The project will be funded by donations and charities.
If anyone is interested in learning more about the programme please visit
echoinafrica.org.
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - September 15, 2014 Category: Cardiology Authors: sadian Source Type: forums
