Cardiology MCQ: Beta blocker in heart failure
Which of the following beta blocker in heart failure had no benefit?
a) Carvedilol
b) Metoprolol extended release
c) Nebivolol
d) Bucindolol
Correct answer: d) Bucindolol
Bucindolol is a beta blocker with partial agonist activity, which did not reduce mortality in heart failure trial [Beta-Blocker Evaluation of Survival Trial (BEST) Investigators. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med. 2001;344:1659 –1667].
Earlier on beta blockers were contraindicated in heart failure because of their negative inotropic effects. But later several large scale trials showed th...
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
Cardiology MCQ 323: Beta blocker in heart failure
Which of the following beta blockers had no benefit demonstrated in treatment of heart failure?
a) Carvedilol
b) Metoprolol extended release
c) Nebivolol
d) Bucindolol
["Click here for the answer with explanation", "Correct Answer:"]
d) Bucindolol
Bucindolol is a beta blocker with partial agonist activity, which did not reduce mortality in heart failure trial.
The post Cardiology MCQ 323: Beta blocker in heart failure appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - September 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
Inferior ST Elevation. BP 250/140.
This 50-something patient with no previous CAD complained of havinng had chest pressure the day prior, but stated she was asymptomatic at the time of the ECG. Her blood pressure was 250/140. She was well appearing. She admitted to long standing untreated hypertension.Sinus rhythm. Very high voltage in the precordium, meeting criteria for LVH, though without the repolarization abnormalities typically associated. There is ST elevation in inferior leads that is diagnostic of focal injury. The T-wave is inverted in these leads; this is a strong sign of recent reperfusion of the infarct-related art...
Source: Dr. Smith's ECG Blog - September 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
CoQ10: Powerful Supplement for Health
Discussion of the Evidence, Scope, Benefits and Risk. Please take a look at this discussion as I’m certain it will help answer some important questions. In addition, some very informative research about coenzyme Q10 can be found in the science section of our website.
Coenzyme Q10 is one of the most fundamentally important nutritional supplements I recommend and use in my clinical practice not just for patients with heart disease, but to support brain health and general health as well. We generally recommend 100mg daily, and 200mg daily for those on statins, beta-blockers, or tricyclic antidepressants.
The post CoQ10: Pow...
Source: Renegade Neurologist - A Blog by David Perlmutter, MD, FACN - August 19, 2014 Category: Neurologists Authors: gbadmin Tags: Science Supplements beta-blockers blood pressure Cardiovascular disease Cholesterol CoQ10 heart lipitor migraines Statins toprol zocor Source Type: blogs
FDA Recalls Another Batch Of Generic Metoprolol
The FDA has recalled more than 13,000 bottles of metoprolol succinate extended release tablets manufactured by Dr. Reddy’s Laboratories. Two months ago the agency recalled another lot of generic metoprolol from a different company, Wockhardt. Both recalls were for medicines manufactured at facilities in India. There have been multiple reports in recent years of problems with generic drugs made in India. … Click here to read the full post on Forbes. (Source: CardioBrief)
Source: CardioBrief - June 24, 2014 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics FDA generics India metoprolol Source Type: blogs
Wheat And Atrial Fibrillation? A Look At the Correlation
I have personally witnessed improvements in the duration and frequency of the common abnormal heart rhythm, atrial fibrillation, or A Fib, about a dozen times. (This discussion only applies to intermittent A Fib, not chronic, 24-hour-a-day A Fib; the latter condition does not appear to be influenced by diet, as it is a much more advanced situation.) Someone with, say, 4 or 5 10-minute long episodes per week, for instance, can experience a marked reduction in the frequency and duration of episodes, sometimes complete elimination.
Relief from A Fib is a truly wonderful thing because it spares you from the risk for stroke th...
Source: Wheat Belly Blog - May 29, 2014 Category: Cardiology Authors: Dr. Davis Tags: Atrial fibrillation Source Type: blogs
Wheat and atrial fibrillation?
I have personally witnessed improvements in the duration and frequency of the common abnormal heart rhythm, atrial fibrillation, or A Fib, about a dozen times. (This discussion only applies to intermittent A Fib, not chronic, 24-hour-a-day A Fib; the latter condition does not appear to be influenced by diet, as it is a much more advanced situation.) Someone with, say, 4 or 5 10-minute long episodes per week, for instance, can experience a marked reduction in the frequency and duration of episodes, sometimes complete elimination.
Relief from A Fib is a truly wonderful thing because it spares you from the risk for stroke th...
Source: Wheat Belly Blog - May 29, 2014 Category: Cardiology Authors: Dr. Davis Tags: Atrial fibrillation Source Type: blogs
Inferior and Posterior STEMI. What else?
A male in his late 30's to early 40's presented with 24 hours of intermittent typical chest pain. The following ECG was recorded:There is an obvious acute inferior STEMI. The inferior Q-waves suggest that there is an old inferior MI or that this one is subacute, but an old ECG was available and also had similar Q-waves.. There is also ST depression in V2 and V3, also minimal in V4-V6. This is posterior injury, which frequently is simultaneous with inferior injury. There are also large R-waves in V2 and V3, which could represent infarction of the posterior wall. &nbs...
Source: Dr. Smith's ECG Blog - May 10, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Incredible Case Demonstrating the Value of Frequent Serial ECGs
This case is presented and written by Vince DiGiulio, (EMT-Critical Care and emergency department tech). As his title shows, he is a tech. Not a paramedic. Not a nurse. Not a doctor. He is a wizard at reading ECGs and is entirely self-taught. He was the ECG tech on this case, and his skills mean that he recognized the pathology on the ECG and could stand there and keep recording them.A 75 year old female presents with a chief complaint of “reflux.” Starting about five days ago, a couple of times each day she has experienced a burning sensation behind the lower third of her ...
Source: Dr. Smith's ECG Blog - April 18, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Non STEMI that needs the cath lab now.
A male in his 60's called 911 for chest pain. He had some cardiac risk factors including hypertension, on meds, but no previous coronary disease. His pain was intermittent and he was vague about when it was present and when it was resolved. Here is his prehospital ECG:Diagnosis? He had an immediate ED ECG:There is artifact, but the findings appear to be largely gone nowThe diagnosis is acute MI, but not STEMI. There is slight ST elevation in lead III with reciprocal ST depression in aVL. The T-wave is inverted in III, indicating reperfusion (what I like to call "inferior Wellens' s...
Source: Dr. Smith's ECG Blog - April 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Paroxysmal SVT (PSVT) that repeatedly recurs in spite of successful conversion with adenosine
An elderly male complained of dyspnea. His pulse was regular at just under 150. BP was 110/70. There was no evidence of shock or pulmonary edema. Here is his ED ECG:There is a very rapid, wide complex tachycardia (QRS = 150 ms). There are no P-waves before the QRS's. There is a definite Right Bundle Branch Block and Left Anterior Fascicular Block pattern, so this is not VT. The bifascicular block was new. It could be a new block, or a rate-related BBB If you look closely, you can see the inverted (retrograde) P-waves. (See annotated ECG below, with arrows pointing ...
Source: Dr. Smith's ECG Blog - January 31, 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
Ischemic Chest Pain and Hypertension: Use of Adjunctive Anti-ischemic Therapy
A middle aged male with several CAD risks has had several months of exertional angina relieved by rest and nitro. He had the onset of chest discomfort at rest and presented by ambulance about 3 hours later with "severe crushing chest pain," with a blood pressure of 200/100 and pulse of 100. The prehospital ECG cannot be found. Here is his initial ED ECG:Sinus rhythm, nearly tachycardia. Left axis deviation with QRS of 90 ms, R-wave peak time in aVL perhaps reaches 45 ms, so possible left anterior fascicular block. There is minimal ST depression (but also a wandering baseline) in V3-V6.Exam was...
Source: Dr. Smith's ECG Blog - January 7, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Beta Blockers in Anterior STEMI: Have We Come Full Circle?
A new small randomized trial suggests that early intravenous metoprolol, early after symptoms and prior to PCI for anterior STEMI, reduces infarct size.History --The data for beta blockers in the pre-reperfusion era was positive. --Based on this weak data, beta blockers were class I for STEMI for many years. --However, the data for them in the thrombolytic era was not positive, and one might say is was negative (COMMIT trial from China, huge, showed no benefit and an increased rate of cardiogenic shock). --Based on this, recommendations bec...
Source: Dr. Smith's ECG Blog - December 7, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
