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
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
Why is there a young woman advantage? Why is it lost?
The answer to this question has been elusive. The Women’s Health Initiative was supposed to answer these questions but failed to find the advantage. During my stent as cardiology champion, the notion of fundamental laws of biology and a model of health and disease began to form. I used these principles to determine the difference between men and women. The results of this endeavor are now available on line in the article. Houck, PD. Why is there a young woman advantage? Why is it lost? Applying the laws of biology to men and women. JCvD 2014. In press.
The link is
https://urldef...
Source: Doc2Doc BMJ Cardiology - June 22, 2014 Category: Cardiology Authors: Houckster Source Type: forums
Why is there a young woman advantage? Why is it lost?
The answer to this question has been elusive. The Women’s Health Initiative was supposed to answer these questions but failed to find the advantage. During my stent as cardiology champion, the notion of fundamental laws of biology and a model of health and disease began to form. I used these principles to determine the difference between men and women. The results of this endeavor are now available on line in the article. Houck, PD. Why is there a young woman advantage? Why is it lost? Applying the laws of biology to men and women. JCvD 2014. In press.
The link is
https://urldef...
Source: Doc2Doc BMJ Cardiology - June 22, 2014 Category: Cardiology Authors: Houckster Source Type: forums
ca-125 in heart failure
I have seen a lady today who has heart failure with moderate/severe lv impairment on echo with normal rv size and estimated systolic pulmonary artery pressure. she also has ascites which appears to have increased in volume whislt her peripheral oedema hasn't changed (she's never had that much). The ca-125 is >500 (normal range for our lab<10) - do you think this could all be heart failure?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - June 16, 2014 Category: Cardiology Authors: sadian Source Type: forums
Clinical question of the week - do you really believe in heart failure with preserved ejection fraction?
I was talking to a colleague this week about an 80 year old lady with a resting heart rate of 55bpm who had been diagnosed with heart failure with preserved (normal) ejection fraction. His comment was
'' well I always question myself when I make this diagnosis, because you know'..."
I can see his point - the diagnostic criteria vary. For example NICE criteria require the clinical syndrome of heart failure but not any imaging changes whereas the ESC criteria require some imaging change eg left atrial dilation or left ventricular hypertrophy. Do you really believe in this entity? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 16, 2014 Category: Cardiology Authors: sadian Source Type: forums
Clinical question of the week - do you really believe in heart failure with [reserved ejection fraction?
I was talking to a colleague this week about an 80 year old lady with a resting heart rate of 55bpm who had been diagnosed with heart failure with preserved (normal) ejection fraction. His comment was
'' well I always question myself when I make this diagnosis, because you know'..."
I can see his point - the diagnostic criteria vary eg NICE criteria require the clinical syndrome of heart failure but not any imaging changes whereas the ESC criteria require some imaging change eg left atrial dilation or left ventricular hypertrophy. Do you really believe in this entity? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 11, 2014 Category: Cardiology Authors: sadian Source Type: forums
Clinical question of the week - do you really believe in heart failure with reserved ejection fraction?
I was talking to a colleague this week about an 80 year old lady with a resting heart rate of 55bpm who had been diagnosed with heart failure with preserved (normal) ejection fraction. His comment was
'' well I always question myself when I make this diagnosis, because you know'..."
I can see his point - the diagnostic criteria vary. For example NICE criteria require the clinical syndrome of heart failure but not any imaging changes whereas the ESC criteria require some imaging change eg left atrial dilation or left ventricular hypertrophy. Do you really believe in this entity? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 11, 2014 Category: Cardiology Authors: sadian Source Type: forums
what to do next for this man?
A colleague rang me this morning about a 65 year old man.
background ischaemic cardiomyopathy -angio last week no targets for revascularisation
suitable for a bivent ICD as EF 25% and has lbbb on ecg
worsening heart failure - put on 3kg over past 24 hours on furosemide 80mg / 40 mg iv, spironolactone 25mg, ramipril 2.5mg and bisoprolol 5mg
BP 120 systolic, creatinine 110 , sodium now 122 (was normal 1 week ago)
what would you do next?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - December 16, 2013 Category: Cardiology Authors: sadian Source Type: forums
ECG: What will you do for a 65 yr old lady diagnosed and treated for Chronic Stable heart failure?
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 7, 2013 Category: Cardiology Authors: Sachin India Source Type: forums
ALTITUDE Autopsy Shows What Went Wrong With Aliskiren
In its short lifespan the direct renin inhibitor aliskiren (a.k.a., Rasilez or Tekturna) rapidly declined from being a highly promising, first-of-its kind drug to a major failure. The death blow was struck last December with the early termination of the ALTITUDE trial, after the data and safety monitoring committee found an increased risk in patients taking aliskiren. Now the final results of the Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints have been presented at Kidney Week 2012 in San Diego and simultaneously published in the New England Journal of Medicine.
8,561 type 2 diabetics at high risk f...
Source: CardiologyNetwork.com - October 13, 2013 Category: Cardiology Authors: Indian Diabetics Foundation Team Source Type: forums
Would you join SAD?
Minerva covers some research that has recently been published regarding increased mortality and treatment with digoxin and reminding us about SAD (society against digoxin). To be honest I can't remember the last time I prescribed digoxin outside of the context of AF.
http://www.bmj.com/content/347/bmj.f5976
Do you recommend digoxin in the setting of heart failure?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - October 13, 2013 Category: Cardiology Authors: sadian Source Type: forums
Ejection Fraction and Heart Failure
(Source: Cardiac Forum)
Source: Cardiac Forum - October 9, 2013 Category: Cardiology Source Type: forums
Is heart failure the most lethal complication of diabetes?
I've been following a debate at the European Diabetes meeting on this point. The argument is that diabetologists and cardiologists fail to notice that heart failure is the most adverse outcome of diabetes and is killing more patients than we seem to notice. Is this right? And more importantly should we do anything about it?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - September 30, 2013 Category: Cardiology Authors: sadian Source Type: forums
