How to manage a patient with LA clot and Mitral stenosis ?
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AnswerÂ
Though PTMC in the presence of LA clot is an option in low risk clots , my strategy would be the last one ,whenever feasible. Intensive, monitored Heparin /Oral anticoagulants ( Heparin 5000 units tds or qid or Low molecular weight heparin Enoxaparin Â...
Source: Dr.S.Venkatesan MD - February 3, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
How doctors add stress to the poor IVF patient's life
Being infertile is bad enough, and an IVF cycle is stressful because you are never sure whether it's going to work or not. Not only is the uncertainty difficult to handle, the fact that it's so expensive just adds to your anxiety. While we can't reduce the uncertainty which plagues IVF , the tragedy is that IVF doctors often add insult to injury , by making the treatment unnecessarily stressful .For one thing, they subject patients to lots of useless tests, which are completely unnecessary , because they don't change the treatment options we can offer to patients. They justify these by doing it under the garb of being " co...
Source: Dr.Malpani's Blog - January 28, 2018 Category: Reproduction Medicine Source Type: blogs
How doctors add stress to the poor IVF patient's life
IVF treatment is stressful as it is , and many doctors make it even more stressful. Being infertile is bad enough, and an IVF cycle is stressful because you are never sure whether it's going to work or not. Not only is the uncertainty difficult to handle, the fact that it's so expensive just adds to your anxiety.While we can't reduce the uncertainty which plagues IVF , the tragedy is that IVF doctors often add insult to injury , by making the treatment unnecessarily stressful .For one thing, they subject patients to lots of useless tests, which are completely unnecessary , because they don't change the treatment options we...
Source: Dr.Malpani's Blog - January 11, 2018 Category: Reproduction Medicine Source Type: blogs
Palliative Care & CHF: PAL-HF trial
The main results of PAL-HF - a randomized, controlled trial of specialty palliative care team involvement in advanced heart failure patients - have just been published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2017.05.030. Clinicaltrials.gov registration here). This is an important, well-done study, with encouraging results - specialty PC improved the quality of life of patients with HF. I ' ll discuss the results in more details in this post.The study was done by a multi-disciplinary team of palliative& cardiology investigators at Duke. This week ' s ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2017 Category: Palliative Care Tags: chf heart failure research research issues rosielle Source Type: blogs
Comparative effectiveness research in action: enoxaparin versus fondaparinux for acute coronary syndrome
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - July 9, 2017 Category: Internal Medicine Tags: cardiovascular pharmacology Source Type: blogs
In Which I Go Under The Knife And Learn About Medicine In The Real World
I’m not a doctor but I thought I knew something about anticoagulation. Over the course of a career covering cardiology I’ve written countless stories about heparin, warfarin, the low molecular weight heparins, and the new oral anticoagulants. So when I had bilateral total knee replacement a few weeks ago I thought I knew what to...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - January 27, 2017 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics anticoagulation aspirin Evidence-based medicine Lovenox total knee replacement Xarelto Source Type: blogs
Understanding head injuries
Ski season is here, and I am reminded of the story of Natasha Richardson (Liam Neeson’s wife), who tragically died of a head injury while skiing without a helmet in 2007. Here in the emergency department, we see many patients with concern for head injuries. We factor what may have caused the injury, your age, what we find when we examine you, the timing of the incident, the medicines you take, as well as some other factors, when deciding whether to do a CT scan or admit you to the hospital.
When a head injury causes bleeding in the brain
Ms. Richardson died of an epidural hematoma, one of several types of brain bleeding,...
Source: Harvard Health Blog - January 18, 2017 Category: Consumer Health News Authors: Jonathan Nadler, MD Tags: Brain and cognitive health Injuries Prevention Safety Source Type: blogs
Why do IVF doctors write such irrational prescriptions ?
This is a standard prescription from a leading IVF clinic in India.There are 8 medicines described for luteal phase support after the frozen embryo transfer.This is a textbook example of needless polypharmacy and irrational prescribing.The only 2 medicines which are needed for luteal phase support are estrogen and progesterone - which are Susten and Progynova. This much is rational.Duphaston contains progesterone, as does Gestone. Why prescribe 3 different medicines which serve exactly the same purpose and contain the same hormone ?Pregynl contains HCG and has no role to play in a frozen ET because there is no corpus luteu...
Source: Dr.Malpani's Blog - November 21, 2016 Category: Reproduction Medicine Tags: irrational prescribing ivf IVF medications IVF prescription Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 7
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Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7.
You scored %%SCORE%% out of %%TOTAL%%.
Your performan...
Source: Cardiophile MD - January 23, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 4
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Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test.
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Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 4.
You scored %%SCORE%% out of %%TOTAL%%.
Your performan...
Source: Cardiophile MD - January 18, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
What Do We Know About Medical Errors Associated With Electronic Medical Records?
By ROSS KOPPEL
Recently, the Journal of Patient Safety published a powerful and important article on the role of EHRs in patient harm, errors and malpractice claims. The article is open access. Electronic Health Record–Related Events in Medical Malpractice Claims by Mark L. Graber, Dana Siegal, Heather Riah, Doug Johnston, and Kathy Kenyon. 

The article is remarkable for several reasons:
Considerably over 80% of the reported errors involve horrific patient harm:Â many deaths, strokes, missed and significantly delayed cancer diagnoses, massive hemorrhage, 10-fold overdoses, ignored or lost critical lab results, ...
Source: The Health Care Blog - January 11, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
"How could I convince my interventionalist to come do a cath in the middle of the night?"
I just received this email today. I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients. I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center. They did not take him to the cath lab emergently. When he went to the cath lab t...
Source: Dr. Smith's ECG Blog - August 27, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Venous thromboembolism in cancer – Cardiology MCQ
Which of the following cancer has the highest relative risk of venous thromboembolism?
a) Pancreatic cancer
b) Brain cancer
c) Multiple myeloma
d) Colonic cancer
Correct answer: c) Multiple myeloma
Multiple myeloma has forty six fold risk of venous thromboembolism than healthy controls while brain cancer has twenty fold and pancreatic cancer sixteen fold relative risk. But by absolute numbers, most episodes occur with lung, colon and prostate  cancer [1]. Chemotherapy confers six fold extra risk though chemotherapy per se is not considered an indication for prophylactic anticoagulation in ambulatory patients, the exceptio...
Source: Cardiophile MD - June 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Elimination of unfractionated heparin – Cardiology MCQ
Principal route of elimination of unfractionated heparin:
a) Renal
b) Hepatic
c) Reticuloendothelial system
d) None of the above
Correct answer: c) Reticuloendothelial system
Unfractionated heparin being a large molecule, is eliminated mainly by the reticuloendothelial system, like abciximab. Renal excretion plays only a minor role in the elimination of unfractionated heparin from the body and hence it can be used with better safety profile in the presence of renal dysfunction. In contrast, a significant amount of low molecular weight heparin (most commonly used being enoxaparin) is eliminated by renal excretion (about for...
Source: Cardiophile MD - May 30, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Catheter thrombosis with Fondaparinux
Catheter thrombosis with Fondaparinux is due to:
a) High anti-Factor Xa activity
b) Low anti-Factor IIa activity
c) High factor VIIIa activity
d) Low factor Xa activity
Correct answer: b) Low anti-Factor IIa activity
Though Fondaparinux is a safe and effective in the management of ST elevation myocardial infarction, it was associated with a higher incidence of guide catheter thrombosis in those who underwent percutaneous coronary intervention. The same concern applies to non ST elevation acute coronary syndromes where fondaparinux is ideal in terms of lower bleeding risk, albeit with a potential risk of guide catheter thro...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology MCQ Coronary Interventions DM / DNB Cardiology Entrance Source Type: blogs
