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
The end of therapeutic hypothermia post cardiac arrest?
There is an editorial in the BMJ this week covering the Targeted Temperature management trial (TTM) trial of cooling to 33 degrees versus 36 degrees in cardiac arrest survivors who remain comatose post resuscitation. The results appear clear cut - cooling is harmful - going against what we have previously believed and done for that matter. Will this change your practice?
http://www.ncbi.nlm.nih.gov/pubmed/24237006?dopt=Abstract&access_num=24237006&link_type=MED
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 7, 2014 Category: Cardiology Authors: sadian Source Type: forums
dietary fibre post MI
This study caught my eye
http://www.bmj.com/content/348/bmj.g2659
regarding increasing dietary fibre (particularly cereal fibre ) and reduction in all cause mortality post MI.
Time to invest in Kellogg's shares or wait until the next dietary piece of advice comes along?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 3, 2014 Category: Cardiology Authors: sadian Source Type: forums
quality improvement in cardiology
I was at a meeting today when we were discussing quality improvement in cardiology - which interventions have had the biggest impact in your practice?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 29, 2014 Category: Cardiology Authors: sadian Source Type: forums
Would you prescribe the polypill?
A systematic review by the Cochrane Collaboration has said that inconsistencies in the design of studies of the polypill make the impact of the drugs difficult to provide. The review showed that polypills have yet to show that they reduce mortality or heart attack and stroke, but they do reduce risk markers, such as stroke and cholesterol.
Another study has found that a single pill can increase adherence to drug regimes by up to 33%.
Doc2doc has debated the polypill before but does the latest study change your thinking in anyway?
Previous doc2doc debates: http://bit.ly/1khiPXG http://bit.ly/1lsLufa
(So...
Source: Doc2Doc BMJ Cardiology - April 29, 2014 Category: Cardiology Authors: AnneG Source Type: forums
domperidone and the heart
The European medicines agency has recommended that domperidone doses and indications should be restricted because of cardiovascular risks such as QTc prolongation and VT. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Domperidone-containing_medicines/human_referral_prac_000021.jsp&mid=WC0b01ac05805c516f
Personally I don't think I have ever seen such cardiovascular side effects but this may be because domperidone is not prescribed to any extent locally - has anyone else seen such cases?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 27, 2014 Category: Cardiology Authors: sadian Source Type: forums
A case of generalized disability and muscle weakness.
Ghofran is 42 year old female who presented with fatigue, joint pain, proximal muscle weakness and agonising whole body pain. Nothing remarkable on her examination. Upon investigation for connective tissue disease everything was normal. Her vitamin D level was severely lowered. Again her related metabolic profile was normal and no obvious cause for the vitamin D deficiency. I commenced her on high dose ergocalciferol. On follow up visit one month later a failure to increase vitamin D is noticed and the patient still suffering. I am eager to read your kind responses to this dilemma case and your suggestions about next step....
Source: Doc2Doc BMJ Cardiology - April 27, 2014 Category: Cardiology Authors: Majid Hameed Source Type: forums
Diagnosing an MI afterwards
Hello,
I haven't posted in a while so I thought I'd throw a quick question out there that I was asked by a patient while out volunteering with the ambulance service. The patient asked me how MIs can be diagnosed later in the day after the attack itself has passed. I explained to him about how the ECG would show ischemic changes and then about how blood tests can detect cardiac markers. Firstly, what actually are these cardiac markers, and secondly, how long will they remain in the blood? How long after an MI can one be diagnosed as having happened?
Cheers,
Sam (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 19, 2014 Category: Cardiology Authors: samrneal Source Type: forums
Citizen Resus really does make a difference!
Dateline Warwick, UK
Mayor Bob Dhillon was hearing a speech on his retirement from the Chair of Warwick's Ditrict Council when the speaker Richard Davies collapsed. The Mayor is also a youth team coach for Racing Club Warwick FC and applied the lessons he had learnt on resuscitation. Advanced CPR brought Councillior Davies back from cardiac arrest "four or five times" said Mayor Dhillon as Cllr. Davies was taken to Coventry' University Hospital where he is stable.
Well done Mayor Dhillon, who must be a shoo-in for another term!
John (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 15, 2014 Category: Cardiology Authors: John D Source Type: forums
Citizen Resus really doees make a difference!
Dateline Warwick, UK
Mayor Bob Dhillon was hearing a speech on his retirement from the Chair of Warwick's Ditrict Council when the speaker Richard Davies collapsed. The Mayor is also a youth team coach for Racing Club Warwick FC and applied the lessons he had learnt on resuscitation. Advanced CPR brought Councillior Davies back from cardiac arrest "four or five times" said Mayor Dhillon as Cllr. Davies was taken to Coventry' University Hospital where he is stable.
Well done Mayor Dhillon, who must be a shoo-in for another term!
John (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 15, 2014 Category: Cardiology Authors: John D Source Type: forums
why thrombolytics are contraindicated in NSTEMI & Unstable Angina?
good evening /morning dear fellowsi have one confusing question for me & i really need to get a clear, reasonable answer "explaination" for it >>>why thrombolytics are Contraindicated in ACS except in STEMI of course ?thank you in advance ^_^ (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 10, 2014 Category: Cardiology Authors: doctor fatima Source Type: forums
Anp
can anyone plz explain ANP action on heart and diferences happened on heart after MI ?? and if it has any relation to collateral circulation on heart ??
thanx in advance :) (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 6, 2014 Category: Cardiology Authors: Daradkah Source Type: forums
head injury and novel anticoagulants
The NICE guideline writing committee on head injury have repsonded to a recent letter in the BMJ regarding whether to recommend head CT following a head injury in patient's who are taking a novel oral anticoagulant. The comment is that there is not enough data as it is too soon in the lifetime of these drugs. Has anyone seen a head injury in a patient taking one of the newer drugs?
http://www.bmj.com/content/348/bmj.g2297
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - April 3, 2014 Category: Cardiology Authors: sadian Source Type: forums
a 24 year old with an anterior myocardial infarction
We have just been referred the case of a 24 year old man who has undergone angioplasty and stenting to the left anterior descending artery 3 weeks ago following an anterio myocardial infarction. He has now moved to this region hence the referral. What investigations would you do for this man?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - March 31, 2014 Category: Cardiology Authors: sadian Source Type: forums
JBS3 just launched!
JBS3 have just launched the latest CV risk calculator
http://www.jbs3risk.com/
personally I like the layout and think this is an improvement.
What 's your favoured risk calculator and why?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - March 28, 2014 Category: Cardiology Authors: sadian Source Type: forums
