Tuesday, September 17, 2013

EKG card # 10th! Velocity of Conduction of Electrical Impulses (EKG made easy !)

New York Heart Association (Grading for dyspnoea, palpitation, fatigue and angina in patients with cardiovascular disease)

The New York Heart Association (NYHA) Functional Classification in a Patient with Heart Disease 
Overview: The New York Heart Association (NYHA) developed a functional classification for patients with heart disease. 
Patients: Heart disease must be present. 
(1) limitations on physical activity 
(2) symptoms (undue fatigue palpitations dyspnea and/or anginal pain) with ordinary physical activity  
(3) status at rest
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ECG of the Month

1- What does this tracing shows ?
A) Right Ventricular Hypertrophy 
B) Acute Posterior Myocardial Infarction 

Correct answer:
a) Right ventricular hypertrophy
In this tracing, the QRS axis tends to the right axis deviation (RAD), which should make one think of right ventricular hypertrophy (RVH) first. After the RAD, all other diagnostic features of RVH are found in the precordial leads—namely tall R waves in the right precordial leads, a deep S wave in V6, and downsloping ST-T changes that are more prominent in the right precordial leads. This tracing has all of these features and is from a patient with primary pulmonary hypertension with RVH. In a tracing of acute posterior myocardial infarction, the ST segment is depressed more horizontally, and RAD and a deep S wave in V6 are not part of it.

Source: The Heart.org 

Monday, September 16, 2013

Happy hearts: Positivity plus exercise linked to lower CVD mortality

The association between a positive emotional state of mind and lower mortality in patients with ischemic heart disease is mediated by exercise, according to the results of a new study .
Patients with higher levels of positive affect, which reflects a pleasurable response to the environment and typically includes feelings of happiness, joy, excitement, contentment and enthusiasm, had a 42% lower risk of all-cause mortality at five years and were 50% more likely to participate in an exercise program than those with lower levels of positive affect.
In an adjusted regression model, there was no significant association between positive affect, as measured using the global mood scale (GMS), and cardiac-related hospitalizations. Ischemic heart disease patients with higher levels of positive affect on the GMS had a significant 42% lower risk of all-cause mortality at five years. In addition, these happier patients were also 48% more likely to exercise.

Sunday, September 15, 2013

Multi-systemic effects of ACE inhibitors


Discovery of RAAS occurred more than a century ago when in 1898, Tigerstedt1 and Bergmann demonstrated the existence of a substance (subsequently named renin) in crude extracts of rabbit renal cortex that caused a sustained increase in arterial pressure. Further understanding of RAAS pathway was brought forth by discovery of ANG-I  and II by Skeggs  and colleagues in 1950s. Finally, corticalhormone Aldosterone was discovered whose release was mediated via Ang-II and there by establishing the role of RAAS system in the regulation of blood pressure, fluid and electrolyte balance in the body.fig 1 

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Thursday, September 12, 2013

Roles of Precordial thump and its SHOULD and SHOULDN'Ts in CPR

Although,  precordial thump is relatively ineffective for ventricular fibrillation, and it is no longer recommended for this rhythm. A precordial thump should be considered if cardiac arrest is confirmed rapidly following a witnessed and monitored (ECG) sudden collapse (VF or VT) if the defibrillator is not immediately at hand.
There is insufficient evidence to recommend for or against the use of the precordial thump for
witnessed onset of asystole caused by AV-conduction disturbance.
The precordial thump should not be used for unwitnessed cardiac arrest.
A precordial thump should not be used in patients with a recent sternotomy (eg. for coronary artery grafts or valve replacement), or recent chest trauma.

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Thursday, September 5, 2013

Reduced risk of dementia by Statin use ( Statins halved dementia risk in AF patients)

 Two new studies from Taiwan may have somewhat allayed concerns about cognitive dysfunction being a possible side effect of statins.These new data suggest that high-potency statins may reduce the incidence of dementia in patients with atrial fibrillation and in elderly patients. Nevertheless, before we can know for sure that statins may prevent dementia, a clinical trial confirming these findings is mandatory. Results showed an inverse relationship between statin use and dementia, with the risk of dementia reducing with increasing statin dose. This trend remained in different age, gender, and cardiovascular risk subgroups.The adjusted risks for dementia were significantly inversely associated with increased total or daily equivalent statin dosage. Patients who received the highest doses of statins had a threefold decrease in the risk of developing dementia. High-potency statins such as atorvastatin and rosuvastatin [Crestor, AstraZeneca] showed a significant inverse association with developing dementia in a dose-response manner. Higher doses of high-potency statins gave the strongest protective effects against dementia.All the statins except lovastatin were associated with a decreased risk for new-onset dementia when taken at higher daily doses. Lin suggested lovastatin may have shown different results as it has less cholesterol-lowering effect than other statins.Statins halved dementia risk in AF patientsuring a six-year follow-up, 2.1% of the patients taking statins developed dementia compared with 3.5% of the nonstatin group, a statistically significant difference (p=0.002).Other factors that were associated with a reduced risk of dementia included male sex and lower CHADS2 score. History of MI, peripheral artery disease, coronary artery disease, chronic kidney disease, and valvular heart disease were not associated with new-onset dementia
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Systolic BP changes associated with 1-g increases in sodium intake

Pushing for lower BPs in the elderly

A significant twofold increased risk of cardiovascular disease in elderly patients with systolic blood pressures >150 mm Hg as well as a significantly increased risk of coronary heart disease incidence.While stroke rates were not significantly increased in elderly patients with higher blood pressures, there was an increased risk of all-cause mortality among individuals 55 to 74 years of age with systolic blood pressures >140 mm Hg. The results, presented here today at the European Society of Cardiology (ESC) 2013 Congress, are considered hypothesis-generating at this point, say investigators, but do suggest a new standard for treating older patients.
Currently, the American College of Cardiology Foundation/American Heart Association guidelines recommend a treatment target of <140 mm Hg in individuals 65 to 79 years old, with older patients, those 80 years and older, treated to a target of 140 to 145 mm Hg, if tolerated. The European Society of Hypertension
 (ESH)/ESC recommend all elderly patients with a baseline systolic blood pressure greater than 160 mm Hg be treated to a target of 140 to 150 mm Hg. For fitter elderly individuals, treating to less than 140 mm Hg can be considered, according to the ESH/ESC.
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Monday, September 2, 2013

What murmurs require further work-up and referral?

Losartan Looks Promising in Marfan Syndrome

AMSTERDAM-Hopes that angiotensin-receptor blockers (ARBs) could help reduce aortic dissections in Marfan syndrome got another boost today in the form of a small randomized trial from the Netherlands. Dr Maarteen Groenink (Academic Medical Center, Amsterdam, the Netherlands) presented the COMPARE trial results here at the European Society of Cardiology (ESC) 2013 Congressthis morning.