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The Rise of the Minimalist Workout

The Rise of the Minimalist Workout | Heart and Vascular Health | Scoop.it

People have been trying to figure out forever what the right amount of exercise is, but the focus lately is on the shortest period possible.

In the past, formal recommendations have called for a substantial amount of regular exercise. For example, published guidelines from the Health and Human Services Department in 2008 suggested 150 minutes of moderate exercise per week — the equivalent of five 30-minute walks. The guidelines added that 75 minutes of vigorous exercise a week, like jogging, could be substituted.

These guidelines were based on a large body of science showing that 150 minutes of moderate exercise was associated with a longer life span and a reduced risk of heart disease, diabetes and other illnesses.

Seth Bilazarian, MD's insight:

Studies have shown that 150 minutes of moderate exercise each week is associated with improved longevity and reduced risk of many diseases (obesity, diabetes).
Although these shorter more intense exercises are appealing for "busy" Americans, we don't know if the same long term health effects can be expected. In addition to the shorter time required in these workouts and therefore greater likelihood of adoption by those whop are motivated, another potential benefit is that the shorter duration of pain and discomfort with exercise may be an attractive aspect to help overcome the hurdles to exercise.

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Ellen Diane's comment, June 26, 2013 7:31 AM
I do intervals in my over 40 fitness class:) we do lots of cardio (cardiac:) bursts
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Novel Wireless Devices for Cardiac Monitoring

Novel Wireless Devices for Cardiac Monitoring | Heart and Vascular Health | Scoop.it
It is likely that the cardiac patient of the future, “wired” with a personalized network of biosensors, will be extremely different from the usual patient today. These biosensors will transmit a wealth of data about the patient’s genomic, metabolomics, and clinical responses to daily stimuli to the patient’s smartphone peripheral brain. Once that information is received, the smartphone will process it using sophisticated and personalized modeling software and will direct the patient to take action, for example, to contact his or her physician, to adjust a medication, or to alert emergency medical services of an impending myocardial infarction. These devices have the potential to revolutionize medicine. The eventual integration and study of these devices in the coming years must carefully examine not only the relative safety and efficacy of this technology relative to conventional care but also the impact of this technology on changing the costs of health care by preventing rehospitalization and empowering patients.
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Lyme Disease with cardiac involvement

Lyme Disease with cardiac involvement | Heart and Vascular Health | Scoop.it

Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the heart's upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call "heart block," which can be mild, moderate, or severe.

Heart block from Lyme carditis can progress rapidly.

The cases of three patient who had sudden death has been reported byCDC

 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a1.htm?s_cid=mm6249a1_w

Seth Bilazarian, MD's insight:

Lyme carditis is infrequent but probably under recognized.  I have seen this only once in my career despite living in the part of the country with the highest prevalence.


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Reducing the Risk of Heart Attack and Stroke

Reducing the Risk of Heart Attack and Stroke | Heart and Vascular Health | Scoop.it
Reducing the Risk of Heart Attack and Stroke using The American Heart Association/American College of Cardiology Prevention Guidelines

The authors review use of the ASCVD risk calculator repeatedly over several months to assess risk in a patient and provide positive feedback on the improving risk parameters and lowering of risk through a combination of both lifetstyle changes (diet with weight loss and exercise) and statin therapy.

Seth Bilazarian, MD's insight:

The point is well made that we see with patients who begin to have positive effects on blood pressure, lipids and glucose parameters when they have initial success with weight loss and exercise.  Before patient begin these lifestyle changes they have great skepticism but once patients see the positive impact (especially in fasting glucose) the efforts often intensify and continue.

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Obesity 'linked to 10 cancers'

Obesity 'linked to 10 cancers' | Heart and Vascular Health | Scoop.it

Being overweight and obese puts people at greater risk of developing 10 of the most common cancers, according to research in the Lancet medical journal. Scientists calculated individuals carrying this extra weight could contribute to more than 12,000 cases of cancer in the UK population every year. They warn if obesity levels continue to rise there may be an additional 3,700 cancers diagnosed annually.The study of five million people is the largest to date to confirm the link.

Seth Bilazarian, MD's insight:

Many patients know  the link between obesity and diabetes & heart disease, but the link to cancer is not as well known. This is another reason for urgency to address obesity and overweight for individuals and from a public health standpoint.

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Donovan Baldwin's curator insight, August 18, 9:13 AM

While it is possible to be healthy and overweight, it improves your health future to not have the excess weight.

Richard Haddad's curator insight, August 18, 7:04 PM

les études sont nombreuses qui montrent le rôle du poids et de l’Obésité sur l'apparition du cancer .Ne pas hésiter  a prendre un peu de ZEN FIT dans 4 yaourts  tout au long de la journée

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Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use

Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use | Heart and Vascular Health | Scoop.it
 

The US spends more than $750 billion/ yr  on tests and procedures that do not benefit patients. Although there is no physiological indication for carotid ultrasound in “simple” syncope in the absence of focal neurological signs or symptoms suggestive of stroke, there is concern that this practice remains common for routine syncope workups.

We found that 16.5% of all Medicare beneficiaries with simple syncope underwent carotid imaging and 6.5% of all carotid ultrasounds ordered in 2009 were for this low‐value indication.

For the 15.4% patients with stenosis ≥50%, carotid ultrasound did not yield a causal diagnosis. Only 2% of patients imaged experienced a change in medications after a positive study, and <1% of patients underwent a carotid revascularization procedure.

Seth Bilazarian, MD's insight:

The ultrasound of the carotid artery is often part of the "package" of inappropriate testing that happens with syncope or worse lightheadedness without syncope.  Other commonly ordered tests for syncope are Head CT and echocardiography without signs and symptoms indicating their utility.  Much of the problem comes from emergency room evaluation and hospital admission which leads to accelerated testing to limit patient's length of stay. Most of this would be done better (more effectively and wit greater value)  in the office based assessment by the patient's internist or cardiologist.

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Banning the Handshake From the Healthcare Setting

Banning the Handshake From the Healthcare Setting | Heart and Vascular Health | Scoop.it

Banning the handshake from the health care environment may require further study to confirm and better describe the link between handshake-related transmission of pathogens and disease. Moreover, given the profound social role of the handshake, a suitable replacement gesture may need to be adopted and then promoted with widespread media and educational programs. Nevertheless, removing the handshake from the health care setting may ultimately become recognized as an important way to protect the health of patients and caregivers, rather than as a personal insult to whoever refuses another’s hand. Given the tremendous social and economic burden of hospital-acquired infections and antimicrobial resistance, and the variable success of current approaches to hand hygiene in the health care environment, it would be a mistake to dismiss, out of hand, such a promising, intuitive, and affordable ban.

Seth Bilazarian, MD's insight:

The fist bump although a challenge for the older generation may be the best alternative, if it became socially accepted and widely adopted.

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DundeeChest's curator insight, August 10, 6:31 AM

Knuckle bump!!!

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Can You Recognize a Heart Attack or Stroke?

Can You Recognize a Heart Attack or Stroke? | Heart and Vascular Health | Scoop.it
How would you react to a medical emergency? When it comes to heart attack or stroke, every minute counts. Get to know the signs and symptoms of these life-threatening conditions.
Seth Bilazarian, MD's insight:

Last paragraph is the key...

Whether or not you’re trained to offer help, if you see someone having symptoms of a heart attack or stroke, call for help immediately.  If you’re even thinking about calling 9-1-1, you should call,”

 “Yes other conditions can mimic the signs and symptoms of a heart attack or stroke, but let the emergency physician figure that out in the emergency room.” 

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Donovan Baldwin's curator insight, August 6, 9:49 AM

Two years ago, we had a plumbing emergency at our apartment. When it was over, my wife, who had a few health problems, but no heart problem, said, "I don't feel well. I think I may be having a heart attack."


The maintenance man who was there whipped out his phone and called 911. We were kind of embarrassed when the fire truck and the ambulance with the EMT's showed up. My wife wanted to walk out to the ambulance, but they made her get on the gurney. They headed for the hospital, which was four miles away.


I shut the house up, jumped in the car, and went to the emergency room. There I learned that during the short ride to the hospital, my wife had gone into cardiac arrest, and it had taken several attempts to resuscitate her.


She is better now, but still has mental and physical problems as a result of the event. It was fortunate that the maintenance man, Ben, was there, because, as my wife says, "We would have discussed it for several more minutes and the event would have occurred without medical personnel there." Don't mess around. Learn the symptoms and risk the embarrassment. A red face is better than the alternative.

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Hemoglobin A1c in Nondiabetic Patients Predicts Coronary Artery Disease

Hemoglobin A1c in Nondiabetic Patients Predicts Coronary Artery Disease | Heart and Vascular Health | Scoop.it

Objective: To examine the association between hemoglobin A1c (HbA1c) and the presence, severity, and complexity of angiographically proven coronary artery disease (CAD) in nondiabetic patients.
Patients and Methods: We performed a single-center, observational, cross-sectional study of 1141 consecutive nondiabetic patients who underwent coronary angiography from January 1, 2011, through
December 31, 2011. The study population was divided into 4 interquartiles according to HbA1c levels (<5.5%, 5.5%-5.7%, 5.8%-6.1%, and >6.1%).
Results: Patients with higher HbA1c levels tended to be older, overweight, and hypertensive, had higher blood glucose levels, and had lower glomerular filtration rates. Higher HbA1c levels were associated in a graded fashion with the presence of CAD, disease severity (higher number of diseased vessels and presence of left main and/or triple vessel disease), and disease complexity. After adjustment for major conventional cardiovascular risk factors, compared with patients with HbA1c levels less than 5.5%, the odds ratios of occurrence of CAD in the HbA1c quartiles of 5.5% to 5.7%, 5.8% to 6.1%, and greater than 6.1% were 1.8 (95% CI, 1.2-2.7), 3.5 (95% CI, 2.3-5.3), and 4.9 (95% CI, 3.0-8.1), respectively.
Conclusion: The HbA1c level has a linear incremental association with CAD in nondiabetic individuals. The HbA1c level is also independently correlated with disease severity and higher SYNTAX scores. Thus,
HbA1c measurement could be used to improve cardiovascular risk assessment in nondiabetic individuals.

Seth Bilazarian, MD's insight:

The HgbA1c is a blood test that evaluates blood sugar levels over the last 3 months.  Diabetic patients & physicians use the test to evaluate whether diabetes is in good control and value the measure as more useful than one blood sugar measurement to guide recommendations on diet and medication.  The test can also be used for the diagnosis of diabetes (6.5% is the level).

These authors in India found that even below the diabetic level there is significant risk that can be evaluated stepwise in both the presence of blockages in the coronary arteries but also how severe the blockages are that might increase the need for coronary bypass surgery.

The graphic show that starting at 5.5% each 0.5% increase linearly raises the risk.

If validated, this might be one more way to help patients evaluate risk and might find its way in to future risk calculators.

 

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E-Cigarettes: What to Tell Patients

E-Cigarettes: What to Tell Patients | Heart and Vascular Health | Scoop.it
Channeling Donald Rumsfeld, Dr. Bilazarian outlines both the known and unknown unknowns about e-cigarettes.
Seth Bilazarian, MD's insight:

E-cigarette use has really grown pretty significantly. It does an estimated $1.7 billion in sales and it's currently expected that it will exceed revenue from cigarettes in about 10 years. They're marketed as healthier, as potential quitting aids, and they allow smoking anywhere. The marketing is briefly summarized as "e-cigarettes are healthier, cleaner, and cheaper." Much is not known about these new nicotine delivery devices, but counseling of patients about the hazards is important.

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Average Emergency Department Wait Time

Average Emergency Department Wait Time | Heart and Vascular Health | Scoop.it

30 minutes is the national median wait time to be treated in the emergency department, according to the National Hospital Ambulatory Medical Care Survey in 2010-11. The shortest median wait time: 12 minutes for patients with an immediate need to be seen. As for median treatment time, the clock ticked to slightly more than 90 minutes. 

Source: McCraig LF, et al. MMWR. 2014;63:439

Seth Bilazarian, MD's insight:

For cardiology patients, long wait times in the ED are a hazard because patients with chest pain sometimes say they don't want to go for emergency evaluation because it will take many hours to be evaluated and discharged.  Not going to the ED delays diagnosis for heart attack and delays treatment that can be life saving.

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Trends in Atrial Fibrillation in US, 2000-10

Trends in Atrial Fibrillation in US, 2000-10 | Heart and Vascular Health | Scoop.it

Atrial fibrillation (AF) is one of the most frequently encountered arrhythmias in the hospital. A multidisciplinary approach is required to recognize and treat AF appropriately; to limit the catastrophic consequences such as stroke, heart failure, and dementia; and to decrease the burden on the healthcare system. Hospitalization related to AF is the single largest contributor to overall cost of care in managing AF patients. In this study, we examined the trends of AF hospitalizations in the United States and assessed the effects of patient demographics and comorbid diagnoses on in-hospital mortality, length of stay, and total cost of care. Understanding these factors helps us understand the health economics of AF better. There has been a significant increase in AF hospitalizations over the last decade, with a large contribution from patients >65 years of age, especially among those >80 years of age. The overall length of hospital stay has remained unchanged; however, the cost of inpatient care has increased tremendously, from approximately $2.15 billion in 2001 to $3.46 billion in 2010. To the best of our knowledge, this is the first study to assess the trends of AF-related inpatient care at a national level from the actual hospital discharge database. Such data, although they have inherent limitations, tend to provide more accurate financial trajectory of the problem.

Seth Bilazarian, MD's insight:

Atrial fibrillation or AF is the most common heart rhythm abnormality and it is consistently the first or second most common reason for admission at community hospitals.  We have new therapies such as novel oral anticoagulants (Pradaxa, Xarelto, Eliquis) that should increase the ability to manage this problem as an outpatient but changing the practice of physicians & emergency departments will be difficult.

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Testosterone Replacement Therapy

Testosterone Replacement Therapy | Heart and Vascular Health | Scoop.it
Pentucket Medical cardiologist Seth Bilazarian, MD discusses testosterone replacement therapy in men with "low T." What is the risk of heart attack or stroke?
Seth Bilazarian, MD's insight:

Putting the testosterone replacement for "low T" into perspective for our patients.

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Aspirin for Primary Prevention | Pentucket Medical Associates

Aspirin for Primary Prevention | Pentucket Medical Associates | Heart and Vascular Health | Scoop.it
Aspirin is used to prevent cardiac events like heart attack & stroke. Cardiologist Seth Bilazarian, MD explains aspirin use for primary & secondary prevention.
Seth Bilazarian, MD's insight:

The FDA no longer recommends aspirin for primary prevention

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High Blood Pressure Control Infographic

High Blood Pressure Control Infographic | Heart and Vascular Health | Scoop.it
High Blood Pressure Infographic: Make Control Your Goal
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Donovan Baldwin's curator insight, August 25, 9:16 AM

Lowering your blood pressure is good for you. Learn more about your blood pressure at http://nodiet4me.com/health_products/blood_pressure/articles/index.html

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Donating.vs.Death from CDC

Donating.vs.Death from CDC | Heart and Vascular Health | Scoop.it

Where we donate vs. what kill us. 

Seth Bilazarian, MD's insight:

Many inferences can be made about this disparity but one contributor is clearly the notion (incorrectly) that heart disease is a disease of the elderly and therefore inevitable.  A contributor to this was former surgeon general Jocelyn Elders comment the "you have to die of something".   Much of the public has a dim view of the strides that have been made in cardiovascular disease, but its persistence as a problem in young and old alike requires continued research funding.

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When Patients Read What Their Doctors Write

When Patients Read What Their Doctors Write | Heart and Vascular Health | Scoop.it
Patients are more satisfied with their care when doctors share their medical notes. But letting patients see what doctors put in medical records has long been taboo. That's starting to change.
Seth Bilazarian, MD's insight:

The "open notes" enthusiasts often tout that patients have great benefit going from NO access to compete access.  As a clinician, I have no objection to patients having access to any and all their records but without guidance most of the records are unintelligible and patients often grasp on to abnormal testing results which have no clinical significance ("Why was my ALT or BUN 1 point above the upper limit of normal?" .  

After patients are discharged from the hospital I review all the lab and imaging results, page by page, to ensue that they have heard the results and understand the implications of the results.  

Giving patients copies of these reports in addition to all the other (now mandated) discharge paper works is completely useless and almost never reviewed.

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Global Sodium Consumption & Death from Cardiovascular Causes

Global Sodium Consumption & Death from Cardiovascular Causes | Heart and Vascular Health | Scoop.it

High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain.

In 2010, the estimated mean level of global sodium consumption was 3.95 g/ day, and regional mean levels ranged from 2.18 to 5.51 g/day. Globally, 1.65 million annual deaths from cardiovascular causes were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). 

In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day.

Seth Bilazarian, MD's insight:

Nice multimedia presentation of the current data on salt and cardiovascular disease from NEJM editors.

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Varicose Veins

Varicose Veins | Heart and Vascular Health | Scoop.it

Varicose veins are superficial veins that have become abnormally enlarged and cause symptoms or are cosmetically distressing. Types of varicose veins include spider veins, which are reddish-bluish and thread-like; reticular veins, which are bluish and string-like; and true varicose veins, which are large rope- or worm-like veins that feel spongy to the touch and bulge out from the skin surface.

Seth Bilazarian, MD's insight:

Great review on what varicose veins are, how they occur and strategies for prevention and treatment.

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Triumphs and Regrets of an Early Adopter

Triumphs and Regrets of an Early Adopter | Heart and Vascular Health | Scoop.it

I was thinking recently about adoption of new therapies and what I've gotten right and what I've gotten wrong, and what my regrets and triumphs are in this area. I did this exercise in which I spent several hours thinking about my 20 years in practice, and I thought it would be an interesting exercise to share with you. Hopefully others will weigh in on what they have gotten right and wrong.

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The Soup Can Quiz; 60 seconds of nutritional teaching

The Soup Can Quiz; 60 seconds of nutritional teaching | Heart and Vascular Health | Scoop.it
Seth Bilazarian, MD's insight:

For the last several months I have made it a practice to do the "Soup Can Quiz" with my congestive heart failure patients.  I use the can pictured. All the patients acknowledge that they have heard that they should avoid salt, but after that the knowledge deficits rise quickly.

Patients (almost universally) tell me they don't us ANY salt.

 

What I hear from my older patients who need salt restriction:

1.  "Can't read the label - too small"

2.  "Are you promoting it for sale?:

3.  "Salt isn't listed on the nutrition label"

4.  "The can has a heart on it and says "healthy" so it's ok"

5.  Once prompted about sodium on the label - I ask "knowing that you are supposed to limit yourself to 2000 mg of sodium per day, how much sodium is there if you have this can of soup", I hear....

    -  410 mg - I explain that it is not correct since the servings per container is 2.5 so having the can would be closer to 1000 mg for the whole can.

     - some patients say - "so that means I can have 2 cans"

 

Getting patients to understand that the consequences of exceeding salt recommendations has more immediate consequences such as hospitalization for congestive heart failure and is different than not adhering to a diabetic diet, or strategies for weight loss because consequences for those problems are not as immediate or short term.  The effort has been instructive for me and has helped move patients along the health literacy curve a little bit with the hope of reducing CHF admissions and readmissions.

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Average time to get 5 kinds of appointments for new patients

Average time to get 5 kinds of appointments for new patients | Heart and Vascular Health | Scoop.it
A look at the average time to get five kinds of appointments for new patients in 2013, from a survey of 15 metropolitan areas.
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Global Girth Grows to 2.1 billion

Global Girth Grows to 2.1 billion | Heart and Vascular Health | Scoop.it
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Undetectable Troponin T Level in ED & Risk of Myocardial Infarction

Undetectable Troponin T Level in ED & Risk of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Study to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level & ECG without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).

Background  Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.

Methods  All patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included.

Results  14,636 patients. 8,907 (61%) had an initial hs-cTnT of <5 ng/l.

Among patients with a first hs-cTnT level of <5 ng/l, 1,704 (89%) had a second hs-cTnT level measured, which was <5 ng/l in 1,362 (90%) patients. Patients with a first hs-cTnT level of <5 ng/l and no MI within 30 days were admitted to the hospital for a total of 3,262 days, with a mean duration of hospital stay of 1.5 ± 3.0 days; 1,482 (77%) of these patients were discharged on the same or next day. The most common discharge diagnoses in patients with a first hs-cTnT level of <5 ng/l were nonspecific chest pain (50%), atrial fibrillation or supraventricular tachycardia (5.6%), and angina (5.1%).

Conclusions  All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.

Seth Bilazarian, MD's insight:

The evaluation of chest pain in the emergency department and ability to rapidly evaluate patients, so low risk patients can be released for their comfort &  convenience and for health care cost savings is the "holy grail".  This paper does allot to get us closer. If patients had low level of troponin and a normal EKG there was no heart attack at 30 days in 99.8% and 100% of patients were alive.  Changing protocols in emergency departments will be difficult but achievable.

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Paul Ridker on Inflammation and Residual CV Risk

Paul Ridker on Inflammation and Residual CV Risk | Heart and Vascular Health | Scoop.it

Dr. Bilazarian interviews Dr. Paul Ridker on the inflammation hypothesis and 2 ongoing trials in this area: the National Heart, Lung, and Blood Institute (NHLBI)-funded Cardiovascular Inflammation Reduction Trial (CIRT),[1] which is testing whether taking low-dose methotrexate reduces myocardial infarction (MI), stroke, or death in people with type 2 diabetes or metabolic syndrome who have had a heart attack or have stable coronary artery disease; and the Novartis-sponsored Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS),[2] which is assessing whether blocking the proinflammatory cytokine interleukin (IL)-1β with canakinumab, as compared with placebo, can reduce rates of recurrent MI, stroke, and cardiovascular death in patients post-MI with elevated high-sensitivity C-reactive protein (CRP; ≥ 2 mg/L).

Seth Bilazarian, MD's insight:

Paul Ridker provides a great primer for clinicians & patients on the status of trials investigating the links between inflammation and cardiovascular disease. He reviews the background and status of the two large randomized clinical outcomes trials he leads: CANTOS & CIRT.

 

Other resources:

1.  slides from Dr. Ridker at  https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_426676.pdf

 

2. CIRT trial http://www.thecirt.org/

 

3,  CANTOS trial http://www.thecantos.org/

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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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