Cardiology MCQ: Omapatrilat
Omapatrilat inhibits:
a) Angiotensin converting enzyme
b) Neprilysin
c) Aminopeptidase P
d) All of the above
Correct answer: d) All of the above
Omapatrilat inhibits angiotensin converting enzyme, neprilysin, and aminopeptidase P [McMurray JJ et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004]. This would finally cause vasodilation, natriuresis and diuresis. Hence omapatrilat can have potential use in hypertension and heart failure. Since its actions are not confined to the renin-angiotensin system, its antihypertensive effect occurs in both high renin and...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
MKSAP: 55-year-old man with nonischemic cardiomyopathy
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. Medications are lisinopril, carvedilol, and chlorthalidone.
On physical examination, blood pressure is 150/90 mm Hg and pulse rate is 50/min. No jugular venous distention...
Source: Kevin, M.D. - Medical Weblog - November 15, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
To Bind or Not to Bind?
An 88-year-old man with a history of congestive heart failure, hypertension, and diabetes mellitus presented to the ED from a nursing home with altered mental status. EMS reported that the patient has had a decreased appetite, diarrhea, and weakness for three days. His initial vital signs were temperature 97.9°F, heart rate 79 bpm, blood pressure 116/64 mm Hg, respiratory rate 16 bpm, and pulse oximetry 98% on room air. His physical exam was remarkable for a depressed level of consciousness. Lab findings showed a creatinine of 2.6 mg/dl, a BUN of 60 mg/dl, and normal potassium and magnesium. His ECG is shown below.
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Source: The Tox Cave - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
To Bind or Not to Bind?
An 88-year-old man with a history of congestive heart failure, hypertension, and diabetes mellitus presented to the ED from a nursing home with altered mental status. EMS reported that the patient has had a decreased appetite, diarrhea, and weakness for three days. His initial vital signs were temperature 97.9°F, heart rate 79 bpm, blood pressure 116/64 mm Hg, respiratory rate 16 bpm, and pulse oximetry 98% on room air. His physical exam was remarkable for a depressed level of consciousness. Lab findings showed a creatinine of 2.6 mg/dl, a BUN of 60 mg/dl, and normal potassium and magnesium. His ECG is shown below.
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Source: The Tox Cave - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 42-year-old man with severe burning and stabbing pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes. The pain is more severe at night, is aggravated when the bed sheets touch his skin, and is partially relieved when he walks or massages his feet. The patient has an 8-year history of poorly controlled type 1 diabetes mellitus and a 2-year history of hypertension. He was hospitalized briefly 2 weeks ago for treatment of pneumonia and diabetic ketoacidosis. His fasting blood glucose levels...
Source: Kevin, M.D. - Medical Weblog - October 25, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Endocrinology Neurology Source Type: blogs
MKSAP: 48-year-old man with urinary frequency
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He has a 33-pack-year history of smoking. He has hypertension, chronic kidney disease, and bipolar disorder. Medications are amlodipine, lisinopril, and lithium. He has tried oth...
Source: Kevin, M.D. - Medical Weblog - October 11, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Medications Nephrology Source Type: blogs
MKSAP: 59-year-old woman with pain of the right foot
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications are carvedilol, lisinopril, furosemide, and spironolactone.
On physical examination, vital signs are normal. Examination of the foot reveals tenderness and warmth directly belo...
Source: Kevin, M.D. - Medical Weblog - October 4, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Radiology Source Type: blogs
An 8 year old with diarrhea, abdominal pain, and syncope
This case was sent by:Maria PerezEmergency RegistrarMonash Medical CentreMelbourneShe obtained permission from the family to identify the location or origin of the case.CaseThis previously completely healthy 8 yo girl complained of diarrhea, vomiting, and upper abdominal pain radiating to the chest, for the past 3 days. There had been an episode of syncope 3 days prior for which she had been seen by her primary care provider, but there is no information from that visit. Her exam was normal except for an irregular heart rate at 78, with BP of 100/60. Lungs were clear.Because of the irregular hear...
Source: Dr. Smith's ECG Blog - May 20, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
ST Elevation and Positive Troponin. Is it STEMI? No. And it is not even ACS.
A male in his 60s complained of constant chest pain for 12 hours. He has a h/o DM and HTN and has been off his meds, including clonidine, for 3 days. His first two BP measurements were 176/108 and 191/126, with a pulse of 100-112. Here is his initial ECG:ED ECG with pain:There is sinus tach at a rate just above 100. There is profound LVH, with deep S-waves in V1-V3 and a large R-wave in V6. There is left atrial enlargement, with a very large negative deflection of the P-wave in V1, also supporting LVH. There is 3-4 mm of ST elevation in V1-V3: this is classic for the ...
Source: Dr. Smith's ECG Blog - January 15, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Using FDA Big Data and Electronic Health Records to Improve Drug Safety
In this study, investigators studied how drug combinations act through networks within cells, focusing on the diabetes drug rosiglitazone, an effective drug in controlling blood glucose, according to the press release. However, rosiglitazone has a serious side effect, increased heart attacks, which has restricted its use markedly.
Since most patients with diabetes take more than one drug and the FDA Adverse Event Reporting System (FDAERS) is freely available, "investigators analyzed data from the FDAERS to see if second drugs could lower the rate heart attacks. In addition, investigators compared their results with Mount...
Source: Policy and Medicine - November 22, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs
Yet Another Blow To Combination Renin-Angiotensin-Aldosterone System Blockade
ACE inhibitors and angiotensin-receptor blockers have been found to effectively slow progression of kidney disease. It has been theorized that dual blockade of the renin-angiotensin-aldosterone system (RAAS) might prove even more beneficial, but these hopes have not been realized. Now a new trial published in the New England Journal of Medicine throws further cold water on the once-promising hypothesis. In the Veterans Affairs Nephropathy in Diabetes (VA NEPHRON-D) trial, Linda Fried and colleagues randomized type 2 diabetics with proteinuric kidney disease already receiving the angiotensin-receptor blocker losartan ...
Source: CardioBrief - November 9, 2013 Category: Cardiology Authors: Larry Husten Tags: Policy & Ethics Prevention, Epidemiology & Outcomes ace inhibitor Acute kidney injury ARB chronic kidney disease Renal function Source Type: blogs
Should Have Known Better ...
One would think I should have learned my lessons over the years in maneuvering through the byzantine world of American healthcare delivery (trust me, its not a SYSTEM, folks, but a world where every party involved tries to skip a little extra profit off the ridiculously high premiums Americans already pay), but I routinely find out that's not the case.Over the years, I have shared stories of how I had like 4 different healthcare plans over the past six years yet have been with my employer for the past fifteen, and it wasn't because I switched plans in open enrollment because the only choice I had was to be covered or not. ...
Source: Scott's Web Log - November 8, 2013 Category: Diabetes Tags: 2013 co-pays Dexcom Lisinopril OptumRx United Healthcare Source Type: blogs
99203 CPT ® Code Description, Progress Notes, RVU, Distribution.
This 99203 CPT ® lecture reviews the procedure code definition, progress note examples, RVU values, national distribution data and explains when this code should be used in the clinic and hospital setting. CPT stands for Current Procedural Terminology. This code is part of a family of medical billing codes descr ibed by the numbers 99201-99205. CPT® 99203 represents the mid (level 3) office or otheroutpatient new patient visit and is part of the Healthcare Common Procedure Coding System (HCPCS). Make sure to also review the lecture on thelevel 4 new clinic visit as well. A patient is considered outpatient unti...
Source: The Happy Hospitalist - October 25, 2013 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs
