doctor, why has my blood pressure gone bad?
I saw a lady in the clinic who asked me this question - she has diabetes and ischaemic heart disease . Her blood pressure has been on average 145/ 85 -90 on perindoril 8mg, amlodipine 10 mg and a small dose of thiazide. Suddenly on home monitoring her BP readings are up to 210 / 120 . Her machine has been tested. she is concordant with her medicines and nothing else has happened in terms of symptoms / medicine changes. Any thoughts? sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 28, 2014 Category: Cardiology Authors: sadian Source Type: forums

genetic testing for familial hypercholesterolaemia in the UK
Genetic testing for FH is soon to be available in the UK http://www.bbc.co.uk/news/health-27586009 the story points out that there are some regions of the UK that will not be covered by this service - is this fair and shouldn't a national service be exactly that - national? sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 28, 2014 Category: Cardiology Authors: sadian Source Type: forums

heathy candidate bias in ICD trials?
I've just been reading this http://www.bmj.com/content/348/bmj.g2866 regarding a bias towards 'healthy' candidates for ICD implantation . From what I have seen (and guess practice) this rings very true . The conclusion is that this is 'thoughtful clinical decision making  in which doctors use factors such as frailty to allocate expensive therapies to patients who are most likely to benefit' do you agree? sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 26, 2014 Category: Cardiology Authors: sadian Source Type: forums

adrenaline in nonshockable cardiac arrest
I have to admit I have a personal interest in this paper in timing of epinephrine (adrenaline) in nonshockable arrest. Having worked with lots of cardiac surgeons who 'hate' adrenaline in this setting do you think this is a game-changing paper? I've copied the figure showing likely survival to discharge versus time of administration of adrenaline below. sadian http://www.bmj.com/content/348/bmj.g3028   (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 23, 2014 Category: Cardiology Authors: sadian Source Type: forums

adrenaline in nonshocable cardiac arrest
I have to admit I have a personal interest in this paper in timing of epinephrine (adrenaline) in nonshockable arrest. Having worked with lots of cardiac surgeons who 'hate' adrenaline in this setting do you think this is a game-changing paper? I've copied the figure showing likely survival to discharge versus time of administration of adrenaline below. sadian http://www.bmj.com/content/348/bmj.g3028   (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 23, 2014 Category: Cardiology Authors: sadian Source Type: forums

a wireless pacemaker?
The bbc website is carrying a story about a wireless pacemaker being placed in a rabbit. Potentially revolutionary if it would work in humans! http://www.bbc.co.uk/news/science-environment-27488486 sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 21, 2014 Category: Cardiology Authors: sadian Source Type: forums

Interesting ECG
(Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 21, 2014 Category: Cardiology Authors: ikram2012 Source Type: forums

Do you think hypertension is a stress related disorder?
A common wisdom is that stress elevates the blood pressure. Whether hypertension is a stress-induced disorder or not is a question that haunts many people. I wonder after the advances in genetics is the hypothesis that hypertension is related to type A personality, and stress-induced still valid or not. (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 20, 2014 Category: Cardiology Authors: Sidhom Source Type: forums

another echo spot diagnosis
ok another one to challenge you (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 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

Few questions - Help us improve communication with patients with cardiovascular (heart attack) problems.
Dear Cardiologists, I know how valuable your time is so I will keep it as concise as possible. We are a group of young entrepreneurs, currently taking part in Harvard Business School program "Innovating in Heathcare" and under its auspices we are trying to solve the problem of miscommunication between patients and cardiologists. According to various publications and researches, despite multiple tools and efforts to convey information to patients in an understandable way, there are still significant problems with post-appointment compliance resulting in readmissions and complications what costs billions of dollars ...
Source: Doc2Doc BMJ Cardiology - May 14, 2014 Category: Cardiology Authors: StanislawK Source Type: forums

Respiratory Alkalosis
65 year old patient who was dignosed with primary B cell testicular lymphoma which had gone just to his brain ( frontal lobe) last year in August. He was given chemo which removed his tumor, he then has been given 2 rituximab session uptil now. Recently 3 or 4 days back he started hyperventilating and now has been dignosed with partially compensated resp alkalosis. His PH is 7.5 his Co2 and HCO3 are both 9. His cretinine is slightly elevated too. His lungs are clear. Plz help! (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 12, 2014 Category: Cardiology Authors: princess58 Source Type: forums

echo spot diagnosis
this lady attended the open access echo service last week - can you make a spot diagnosis? sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 12, 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