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🔸#ECG 62B Analysis: Normal sinus rhythm, right atrial hypertrophy (abnormality),
first-degree AV block (prolonged AV conduction), old lateral and anteroapical
myocardial infarction, left ventricular aneurysm, low voltage in limb leads

👉 #ECG 62B shows a regular rhythm at a rate of 78 bpm. There is a P wave before each QRS complex (+) and the PR interval is constant (0.26 sec). The P waves are positive in leads I, II, aVF, and V4–V6.
Hence this is a normal sinus rhythm with a first-degree AV block (prolonged AV nodal conduction). The P waves are tall and peaked in leads II and aVF and all positive in lead V1, consistent with right atrial hypertrophy or a right atrial abnormality. The QRS complex duration is normal (0.08 sec) and there is a normal axis between 0° and +90° (positive QRS complex in leads I and aVF).

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✅ #Summary of Important Trial Results for Interventional #Cardiology From ACC.19

📌COACT: Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation

• The COACT trial (Coronary Angiography after Cardiac Arrest) is the first published randomized clinical trial evaluating the strategy of immediate coronary angiography versus delayed coronary angiography in patients successfully resuscitated after out-of-hospital cardiac arrest with an initial shockable rhythm and no ST-segment elevation on their electrocardiogram.

• A total of 552 patients was randomized. The primary endpoint was survival at 90 days, at which time 64.5% (176/273) of patients receiving immediate angiography and 67.2% (178/265) of patients in the delayed angiography group were alive (odds ratio 0.89; 95% confidence interval [CI], 0.62-1.27; p = 0.51).

• This is the first report of 9 separate randomized clinical trials examining this issue in post-arrest patients without ST-segment elevation. Over the next decade when all of these trials are completed, more than 4,000 patients will have been studied. The COACT trial was well-done.

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🌎 October 1st- #International Elderly Day

❤️Happy International Elderly Day❤️ "The Journey to Age Equality"

✅ Let us review some #cardiovascular related complications that elderly face.

🔹Age related #cardiac structural changes

•Increased left ventricular wall thickness, independent of any increase in blood pressure. This is attributed to hypertrophy of individual myocytes with a progressive loss of myocyte numbers. There is also an accumulation of interstitial connective tissue and, in the “old old”, accumulation of amyloid deposits.

•Increased fibrosis and calcification of the valves, particularly the mitral annulus and the aortic valve.Recently it has been shown that aortic sclerosis without outflow obstruction is not the benign condition once thought and is associated with significantly increased cardiovascular and total mortality.

•Loss of cells in the sinoatrial node. By 75 years of age, only 10% of the cells that ...

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‍ ⚠️ #ECG of the week 109

👈#پاسخ :
🔸#Answer :

✅ Rate:
• 48 bpm
Rhythm:
•Irregular
•Nil P waves visible
Axis:
•Right axis deviation
Intervals:
•QRS – Prolonged
Additional:
•ST Elevation leads I, aVL, V1-4
•ST depression leads III, aVF
•Bizarre broad QRS without typical BBB
•Prominent T waves leads V3-6
Key abnormalities:
•Slow atrial fibrillation
•QRS Prolongation
•High lateral ST elevation
•Prominent precordial T waves
The differentials of these ECG findings are relatively broad but the immediate life-threats would be:
•Acute myocardial infarction
•Hyperkalaemia +/- acidaemia
•Drug toxicity
Other causes include myocarditis, cardiomyopathy and hypothermia.

🔻Clinical Outcome
We must always take our ECG differentials to the bedside and consider them within the clinical presentation and scenario. ECG abnormalities in the acutely unwell diabetic should always prompt consideration of hyperkalaemia and acid-base disturbance as the primary cause. We must also be mindful that diabetic emergencies can be precipitated by acute cardiac ischaemia and also cause hypercoagulable states. ...

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‍ 📚📖#آموزشی : 📚📖

💻👉👉#Watch :

🏨👨🏼‍⚕️Total Anomalous Pulmonary Venous Return (TAPVR)

The pulmonary veins are the four blood vessels (two on each side) that return oxygen-rich blood from the lungs to the left atrium (left upper chamber) of the heart.

Total anomalous pulmonary venous return (TAPVR) is a rare congenital malformation in which all four pulmonary veins do not connect normally to the left atrium. Instead the four pulmonary veins drain abnormally to the right atrium (right upper chamber) by way of an abnormal (anomalous) connection.

Total anomalous pulmonary venous return is classified into different types, based on how and where the pulmonary veins drain to the heart:

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📚 به روز رسانی #اطلاعات 📕📖

✅ Important Interventional Trials From #ESC #Congress 2019: The THEMIS-PCI

🔸The THEMIS-PCI (Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention) report in Lancet1 found that the primary efficacy outcome (a composite of cardiovascular death, myocardial infarction [MI], or stroke) was lower in patients randomized to ticagrelor than to placebo (404 [7.3%] of 5,558 vs. 480 [8.6%] of 5,596; hazard ratio [HR] 0.85; 95% confidence interval [CI], 0.74-0.97; p = 0.013) in the subgroup of patients with a history of PCI.2 However, THEMIS-PCI has major statistical flaws that limit its generalizability:

1.This was a subgroup analysis. The lay press understands that subdividing a main trial into subgroups is limiting because it introduces spurious results.

2.The p-value describing the interaction between PCI and non-PCI patients for the primary outcome was not significant (p = 0.16). ...

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📚 به روز رسانی #اطلاعات 📕📖


✅Randomized Comparison of Clopidogrel Versus Ticagrelor or Prasugrel in Patients of 70 years or Older With Non-ST-Elevation Acute Coronary Syndrome - POPular AGE
🔸Author/Summarized by Author:Anthony A. Bavry, MD, MPH, FACC

Description:
The goal of the trial was to evaluate clopidogrel compared with ticagrelor or prasugrel among patients ≥70 years of age being treated for a non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Study Design
• Randomized
• Parallel
• Open-label

Patients ≥70 years of age with an NSTE-ACS were randomized to clopidogrel (n = 501) versus ticagrelor or prasugrel (n = 502) for 12 months.
• Total number of enrollees: 1,003
• Duration of follow-up: 12 months
• Mean patient age: 77 years
• Percentage female: 37%
• Percentage with diabetes: 29%

Inclusion criteria: ...

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✅Intracoronary Stenting and Antithrombotic Regimen 5 - ISAR-REACT 5
•Author: Anthony A. Bavry, MD, MPH, FACC

Description:
The goal of the trial was to evaluate ticagrelor compared with prasugrel among patients with an acute coronary syndrome undergoing planned coronary angiography.

Study Design
•Randomized
•Parallel
•Open-label

Patients with an acute coronary syndrome undergoing planned early invasive therapy were randomized to ticagrelor (n = 2,012) versus prasugrel (n = 2,006)
Patients randomized to ticagrelor received a loading dose of 180 mg as soon as possible and were continued on 90 mg twice daily.
Patients randomized to prasugrel received a loading dose of 60 mg as soon as possible for ST-segment elevation myocardial infarction (STEMI) and after coronary angiography/before percutaneous coronary intervention (PCI) for non-STEMI (NSTEMI)/unstable angina patients.
Patients were continued on ...

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📚 به روز رسانی #اطلاعات 📕📖

✅ Detection of Coronary Inflammation Using CT: The CRISP-CT Study

✍️It has long been known that atherosclerosis is an inflammatory disease. The recent CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study) provided the most compelling evidence to date on the inflammatory hypothesis of atherothrombosis, highlighting the dual diagnostic and therapeutic benefit of detecting and targeting high levels of residual systemic inflammation in secondary cardiovascular prevention. However, circulating inflammatory biomarkers such as high-sensitivity C-reactive protein may lack specificity for vascular inflammation, underlining the need for more targeted approaches in identifying vascular inflammation at the earliest stages of atherosclerosis. Positron emission tomography (PET) radiotracers, such as F-NaF (sodium fluoride) and Ga-dotatate have been developed to address this unmet need. However, PET imaging has higher radiation exposure than standard coronary computed tomography angiography (CCTA), increased costs, and limited availability in many clinical settings. Developing new approaches to extract functional information from established first-line diagnostic tests such as CCTA would therefore be of great clinical value...

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🌎 Stent - save a life

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🔻#Key CVOTs with Semaglutide: SUSTAIN 6 and PIONEER 6

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📚به روز رسانی #اطلاعات

🔸Key CVOTs with Semaglutide: SUSTAIN 6 and PIONEER 6

✍️Semaglutide is a potent glucagon-like peptide 1(GLP-1) analogue with a high degree of homology to human GLP-1. Two formulations of semaglutide have been approved by the FDA; semaglutide for subcutaneous injection once-weekly (marketed as Ozempic®) and semaglutide for oral administration once-daily (marketed as Rybelsus®). Two large phase 3a pre-approval Cardiovascular Outcomes Trials (CVOTs), SUSTAIN 6 and PIONEER 6, investigated the effects of subcutaneous and oral semaglutide versus placebo on Major Adverse Cardiovascular Events (MACE) in patients with type 2 diabetes (T2D) and high cardiovascular (CV) risk. These trials were designed and conducted in accordance with the 2008 US Food and Drug Administration (FDA) guidance for evaluating CV safety in new glucose-lowering therapies. In both trials, at least 122 first MACE were required to rule out a hazard ratio of 1.8 (preapproval boundary for noninferiority assessment). The SUSTAIN 6 CVOT was designed with the additional requirement of minimum 104 weeks of treatment exposure for assessment of long-term efficacy and safety. Besides the difference that SUSTAIN 6 was both event-driven and duration-driven, and PIONEER 6 was purely event-driven, the design of PIONEER 6 resembled that of SUSTAIN 6. The adjudication process, conducted by an independent and blinded Events Adjudication Committee (EAC), and event definitions were similar across the CVOTs. ...

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🔸Impact on cardiometabolic factors

🔹In both SUSTAIN 6 and PIONEER 6 trials, semaglutide was associated with a favorable impact on systolic blood pressure (SBP) (placebo-controlled reduction in SBP of 1.3 and 2.6 mm Hg with 0.5 and 1mg dose in SUSTAIN 6; 2.6 mmHg reduction in PIONEER 6), weight loss (placebo-controlled weight loss of 2.9 and 4.3 kg with 0.5 and 1mg dose in SUSTAIN 6; 3.4 kg weight loss in PIONEER 6), and glycemic control (placebo-controlled reduction in HbA1c of 0.7% and 1.0% with 0.5 and 1mg dose in SUSTAIN 6; 0.7% reduction in PIONEER 6). The mean pulse rate increased by 2 and 2.5 bpm with 0.5 and 1.0 mg dose of semaglutide in SUSTAIN 6, and by 4 bpm in PIONEER 6.

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🔸Safety of Semaglutide

🔻The safety profile of semaglutide was overall consistent with that of the GLP-1 receptor agonists (RA) class, with gastrointestinal adverse events being the most frequently reported adverse drug reactions with semaglutide. The risk of severe hypoglycemia was low, typically increased in conjunction with SU or insulin therapy. No increased risk of pancreatitis, pancreatic cancer or thyroid medullary cancer was observed, although the duration of exposure was limited. One new safety finding emerged from SUSTAIN 6 – an increased risk of diabetic retinopathy complications primarily in patients with pre-existing diabetic retinopathy (HR 1.76, 95% CI 1.11, 2.78). A similar, but nonsignificant risk was also observed with liraglutide in LEADER.The available data suggest that this might be associated with pronounced improvement in glycemic control as seen with insulin therapy. Despite patients with proliferative diabetic retinopathy being excluded from PIONEER 6, a 0.8% increase in diabetic retinopathy was observed with oral semaglutide. A dedicated ophthalmic trial (FOCUS) of 5 years treatment duration will assess the long-term effect of semaglutide on diabetic retinopathy development and progression...

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📚به روز رسانی #اطلاعات

📌 Older Adults in the #Cardiac Intensive Care Unit: AHA Scientific Statement

🔻The following are key points to remember from this American Heart Association (AHA) Scientific Statement on Older Adults in the Cardiac Intensive Care Unit (CICU): Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care:

1.Delirium is a state of an acute disturbance in awareness and attention that commonly arises during critical illness and contributes to increased hospital mortality, with estimates ranging between 17% and 33%. Older patients with cardiovascular disease (CVD), particularly those with baseline cognitive and sensory limitations, have high susceptibility to ICU–associated delirium (delirium estimate, 9-44%). Although tools to predict and identify delirium are available, new measures and therapies to prevent and treat delirium and related consequences are still needed.

2.Frailty is a clinical state in which there is increased vulnerability to stressors with a higher likelihood of functional decline, complications, and increased mortality from disease and therapeutic interventions. Such vulnerability relates to diminished physiological reserves across multiple physiological systems. Frailty is common among older adults admitted to the CICU, with an estimate as high as 63%. Frail patients with CVD usually have poorer outcomes, with associated risks pertaining to baseline CVD, poor tolerance to medications and procedures, and physical (functional decline, falls, and cognitive impairments)...

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📚 به روز رسانی #اطلاعات 📕📖

✅ Advent Health Ocala’s #ICAM_Protocol Takes on #COVID-19: Clinician Drives Real #World Evidence & Breakthrough

SEP 24, 2020 | ADVENTHEALTH, COVID-19, ICAM, LEADING SITES, NEWS, OFF-LABEL, POPULAR POSTS, PROTOCOL, SITE SUCCESS, SITE WATCH

✍️ Physicians, nurses, and all healthcare workers have served heroically during this pandemic, not only in the U.S. but all over the world. Faced with a novel coronavirus and minimal treatment options, and in the case of remdesivir, severe shortages and high cost—physicians in the clinic seek alternative, safe treatments that can save lives. Recently, a physician working as a director of pharmacy for AdventHealth Ocala faced a challenging situation as #COVID-19 cases spiked while the only provisionally approved medication at the time, remdesivir, was in short supply. What do the physicians in the clinic do? In the case of AdventHealth Ocala, part of the nation’s largest not-for-profit, Protestant-based health system, they tapped into their knowledge and creativity, medical and scientific intellect, and drive and desire to save lives to produce a protocol called ICAM. It appears to be highly effective observationally. If ICAM proves to work consistently, AdventHealth and Dr. Carlette Norwood-Williams have done the nation, and for that matter, the world, a compelling service. Next comes a study to investigate the efficacy of the combination treatment. ...

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⚠️⚠️⚠️🦠🦠🦠

✅ #Coronavirus can last 28 days on glass and currency, study finds

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✅ #Coronavirus can last 28 days on glass and currency, study finds

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✅ Healthy and unhealthy #blood_pressure ranges

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✅ Outcomes of In- and Out-of-Hospital Cardiac Arrest in #COVID_19

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