A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
ueda2012 do we still need high doses-d.mohammedueda2015
This document discusses hypertension and the need for high doses of antihypertensive medications. It provides data showing that over half of adults with hypertension still have uncontrolled blood pressure despite improvements. It also summarizes trials showing residual cardiovascular risk even when blood pressure is controlled. The document advocates for early use of combination antihypertensive therapy, especially those targeting the renin-angiotensin-aldosterone system, to improve control and reduce organ damage. It highlights valsartan specifically as a well-studied angiotensin receptor blocker with strong evidence from numerous trials across cardiovascular conditions.
AHF - Discharge from ICU to the Regular Ward.drucsamal
Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
This document summarizes recent clinical trials evaluating new treatments for heart failure with reduced ejection fraction (HFrEF). It finds that sodium-glucose cotransporter-2 inhibitors (SGLT2i) like dapagliflozin and empagliflozin are now foundational therapies for HFrEF as they reduce mortality, hospitalizations, and improve outcomes. Two novel agents, vericiguat and omecamtiv mecarbil, are described as well-tolerated therapies that may provide additional benefit by reducing residual risk in select HFrEF patients. Vericiguat is now FDA-approved and recommended by guidelines for recent worsening HF, while omecamtiv me
Codes 518.81 (ICD-9 CM) and J96.00-.02 (ICD-10 CM) may be assigned as the principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital and if the selection is supported by the Alphabetic Index and Tabular List for both nomenclatures.
Denervacion renal en hipertension resistenteDaniel Meneses
This document summarizes research on renal denervation for treatment of resistant hypertension. It describes activation of the renal sympathetic nervous system in hypertensive patients and the renal denervation technique. The Symplicity clinical trial program is outlined, including Symplicity HTN-1 and HTN-2 trials showing reductions in blood pressure out to 3 years with the renal denervation procedure. The document concludes that resistant hypertension poses high risk, but renal denervation safely and effectively eliminates renal sympathetic nerves to lower blood pressure in these difficult to treat patients.
This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 patients treated with CRT, 1 death and 3 hospitalizations were prevented. The results provide strong evidence that CRT can improve outcomes for appropriately selected heart failure patients.
A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
ueda2012 do we still need high doses-d.mohammedueda2015
This document discusses hypertension and the need for high doses of antihypertensive medications. It provides data showing that over half of adults with hypertension still have uncontrolled blood pressure despite improvements. It also summarizes trials showing residual cardiovascular risk even when blood pressure is controlled. The document advocates for early use of combination antihypertensive therapy, especially those targeting the renin-angiotensin-aldosterone system, to improve control and reduce organ damage. It highlights valsartan specifically as a well-studied angiotensin receptor blocker with strong evidence from numerous trials across cardiovascular conditions.
AHF - Discharge from ICU to the Regular Ward.drucsamal
Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
This document summarizes recent clinical trials evaluating new treatments for heart failure with reduced ejection fraction (HFrEF). It finds that sodium-glucose cotransporter-2 inhibitors (SGLT2i) like dapagliflozin and empagliflozin are now foundational therapies for HFrEF as they reduce mortality, hospitalizations, and improve outcomes. Two novel agents, vericiguat and omecamtiv mecarbil, are described as well-tolerated therapies that may provide additional benefit by reducing residual risk in select HFrEF patients. Vericiguat is now FDA-approved and recommended by guidelines for recent worsening HF, while omecamtiv me
Codes 518.81 (ICD-9 CM) and J96.00-.02 (ICD-10 CM) may be assigned as the principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital and if the selection is supported by the Alphabetic Index and Tabular List for both nomenclatures.
Denervacion renal en hipertension resistenteDaniel Meneses
This document summarizes research on renal denervation for treatment of resistant hypertension. It describes activation of the renal sympathetic nervous system in hypertensive patients and the renal denervation technique. The Symplicity clinical trial program is outlined, including Symplicity HTN-1 and HTN-2 trials showing reductions in blood pressure out to 3 years with the renal denervation procedure. The document concludes that resistant hypertension poses high risk, but renal denervation safely and effectively eliminates renal sympathetic nerves to lower blood pressure in these difficult to treat patients.
This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 patients treated with CRT, 1 death and 3 hospitalizations were prevented. The results provide strong evidence that CRT can improve outcomes for appropriately selected heart failure patients.
An 83-year-old woman with heart failure was admitted to the hospital for IV diuresis. Her expected 1-year mortality is 43.1% according to a study. For men of the same age, the expected 1-year mortality is 37.9%.
Comparison of the efficacy and safety of new oral anticoagulants with warfari...Khairunnisa Zamri
This document summarizes a meta-analysis comparing the efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) to warfarin for preventing stroke in patients with atrial fibrillation. The analysis pooled data from four randomized controlled trials involving over 100,000 patients. It found that the new oral anticoagulants were as effective or more effective than warfarin at reducing strokes and systemic embolisms, with similar or lower rates of major bleeding. However, they were associated with an increased risk of gastrointestinal bleeding compared to warfarin. The analysis concluded that the new oral anticoagulants provide an improved
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
The study examined the positive predictive value of inpatient and emergency department diagnostic codes for identifying outpatient cases of sudden cardiac death and ventricular arrhythmias in Medicaid and Medicare claims data. Medical records for a random sample of 100 inpatient encounters and 100 emergency department encounters coded with relevant diagnoses were requested and 58% were obtained. First-listed diagnostic codes correctly identified cases 85.3% of the time overall based on criteria in the medical records.
Negligence in Prescribe Drugs Cases (Amputation legs and hands)Nur Ain Atiqa Azeman
On August 18, 2003, Fritzgerald presented to the emergency room of RHD Memorial Medical Center in Dallas, Texas, complaining of abdominal pain, lack of appetite, nausea, vomiting, a history of reflux, and a history of a 30-pound weight loss. The admitting physician consulted with Dr. Richard Holmes, a general surgeon, who determined that Fritzgerald had a duodenal ulcer and needed surgery. Holmes discharged Fritzgerald pending further testing and, 11 days later on August 29, Holmes performed surgery. Fritzgerald tolerated the procedure well. Holmes started Fritzgerald on an antibiotic to prevent a post-surgical abdominal infection and said he expected Fritzgerald to remain in the hospital for about three to five days.
Fritzgerald appeared to be recovering until September 1. Early that morning, Fritzgerald developed a high fever and his blood pressure began to drop. The nursing staff called Holmes about Fritzgerald's condition, and Holmes ordered tests. Fritzgerald exhibited symptoms of systemic inflammatory response syndrome, or sepsis.
In other words, an infection was attacking his entire body. By late evening of September 1, Fritzgerald's condition had deteriorated to septic shock, meaning his organs were not getting adequately profused, and Fritzgerald was in a life-threatening condition. The hospitalist coordinating Fritzgerald's care consulted Prabhakar, an infectious disease doctor.
Prabhakar first saw Fritzgerald around 10 p.m. on September 1. After reviewing all available data and examining the patient, Prabhakar believed Fritzgerald had peritonitis, which is an intra-abdominal infection. Mr.Prabhakar believe the infection could be related to the surgery, but the source of the infection was yet undetermined. Based on his clinical assessment of Fritzgerald's condition, Mr.Prabhakar ordered empiric antibiotic therapy-a broad spectrum antibiotic-to treat the most common pathogens that could cause the infection. The antibiotic therapy Prabhakar prescribed did not treat hospital-acquired Methicillin-Resistant Staphylococcus Aureus (MRSA). The antibiotic was started on the evening of September 1.
Other specialist physician also consulted on Fritzgerald's case, including a pulmonary critical care physician. They ordered numerous tests and chest x-rays, but none was able to determine the source of Fritzgerald's infection. Meanwhile, Fritzgerald's organs began to fail and his body diverted blood flow away from his extremities and to his vital organs through a process called vascular redistribution phenomenon. He was given a drug called Xigris to counteract this phenomenon and was transferred to the intensive care unit.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
Role of Noac (Newer oral aticoagulants) in covid 19 treatment Dr. JaykishanSingh45
1) NOACs have significant drug interactions with some antiviral medications used to treat COVID-19, whereas low molecular weight heparin and unfractionated heparin do not interact.
2) For hospitalized COVID-19 patients, low molecular weight heparin is preferred over NOACs for those admitted to the ICU or who are critically ill. NOACs, low molecular weight heparin, or unfractionated heparin can be used for non-ICU patients.
3) After discharge, extended anticoagulation may be recommended for high-risk COVID-19 patients, with rivaroxaban, apixaban, betrixaban, or enoxapar
Fabry Disease (FD), also known as Anderson-Fabry disease, is an inherited X-linked disorder characterized by the absence (in men) or defi ciency (in women) in α-galactosidase A, activity that causes a progressive accumulation of glycosphingolipids within lysosomes of cells in all the major organ systems and progressive organ damage that fi rst manifests in childhood or early adulthood. End Stage Renal Disease (ESRD) is a major cause of morbidity and premature mortality in FD. We present a male patient with FD who was transplanted with kidney from a living donor and had a sudden cardiac arrest on the 4th day after operation. We suggest detailed preoperative examination including coronary angiography, echocardiography for these patients and also a multidisciplinary care is required for perioperative management of FD patients.
The document discusses the role of the neurofibromin 1 (NF1) gene in cardiovascular development and disease. Key points:
1) Mice lacking the NF1 gene (Nf1-/-) die during embryonic development due to cardiovascular failure and defects in the heart.
2) The NF1 gene's GAP-related domain (GRD) helps regulate Ras signaling and rescues the lethal heart defects seen in Nf1-/- embryos when expressed.
3) However, mice completely rescued from the Nf1 deletion still die shortly after birth, showing the gene is critical for postnatal cardiovascular function.
Heparin-Induced Thrombocytopenia (HIT) is a highly prothrombotic disorder mediated by strong platelet-activating antibodies against multi molecular complexes of platelet factor4 and heparin, leading to consumptive thrombocytopenia and potentially devastating thromboembolic complications. Three alternative anticoagulants have been approved for the treatment of HIT: lepirudin, argatroban, and danaparoidsodium. We present a case of multiple organ embolism secondary to heparin-induced thrombocytopenia after IABP insertion in a cardiac shock secondary to acute myocardial infarction and our fi rst experience with the use of a novel oral anticoagulant, rivaroxaban, to treat a case of HIT-associated thrombosis after IABP insertion.
The document summarizes clinical trials investigating the oral anticoagulant Xarelto for the treatment and prevention of venous thromboembolism (VTE) and arterial thromboembolism. It describes two major studies:
1) The ROCKET AF study found that once-daily Xarelto was non-inferior to warfarin for preventing strokes in atrial fibrillation patients, with lower rates of intracranial bleeding and fatal bleeding.
2) The ATLAS ACS 2-TIMI 51 study found that adding 2.5 mg twice-daily Xarelto to standard antiplatelet therapy after an acute coronary syndrome reduced the composite of cardiovascular death, heart attack, and
Ponencia presentada por el Dr. Josep Comín Colet en el directo ‘IC preservada y resultados del PARAGON-HF’, realizado en la Casa del Corazón el 9 de septiembre de 2019.
This document summarizes several studies related to sacubitril/valsartan (LCZ696):
- The TRANSITION trial found that initiating sacubitril/valsartan in hospital shortly after stabilization from acute heart failure had similar safety outcomes as initiating post-discharge. About 50% of patients achieved the top dose within 10 weeks.
- The PIONEER-HF trial showed that among patients hospitalized for acute heart failure, sacubitril/valsartan led to a greater reduction in NT-proBNP levels at 8 weeks compared to enalapril, with similar rates of adverse events.
- The landmark PARADIGM-HF trial demonstrated that sacubitril
This document appears to be a collection of citations and snippets of text from various medical journal articles and publications. The articles discuss topics related to renal physiology including potassium regulation and excretion, mechanisms of hypertension, genetic disorders involving ion transporters, and case studies of patients presenting with hypokalemia, metabolic alkalosis, and other electrolyte abnormalities. Copyright information is provided for most entries.
Clopidogrel is a pro-drug that requires hepatic metabolism to become active. It is a cornerstone of treatment for acute coronary syndrome (ACS) as dual antiplatelet therapy with aspirin. The CURE trial showed clopidogrel plus aspirin reduces cardiovascular events in ACS patients compared to aspirin alone. Later trials like CREDO found clopidogrel reduces events in patients post-percutaneous coronary intervention compared to aspirin. Newer P2Y12 inhibitors like prasugrel and ticagrelor are more effective at preventing ischemia but with increased bleeding risk. De-escalating dual antiplatelet therapy from newer drugs to clopidogrel appears safe and effective.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Quel enseignement du fait religieux ? (Dominique Santelli)
Session nationale de l'Enseignement Catholique sur l'enseignement du fait religieux.
http://icm.catholique.fr
This document presents a recurring theme over two centuries where new technologies in education are criticized for making students too dependent or replacing important basic skills. Quotes from 1703 to 1950 criticize slates, paper, ink, pens, fountain pens, ballpoint pens and calculators for replacing traditional tools like bark, slate, sharpening pencils and making ink. The final quote from 1985 criticizes calculators and a concluding statement notes we still use older tools but now computers which will likely face similar criticisms of enabling dependence.
This document discusses open education initiatives at Delft University of Technology. It describes how open online courses (MOOCs), open courseware (OCW), and online distance education provide educational resources and opportunities. Open education allows people worldwide to access top-quality education from TU Delft. It supports lifelong learning and accommodates more students. While OCW and MOOCs offer free course materials, online distance education provides accredited certificates and degrees for enrolled students.
This document outlines a company's plan to enter the Russian market. It provides background on the company and an analysis of Russia's market potential. The proposed strategy includes establishing sales offices in Moscow and Yekaterinburg in the short term, and potentially storage facilities and production in Russia in the long term. The company will use trade shows, catalogs, and websites for advertising and distribute products directly to business customers from Germany in the first 5 years.
An 83-year-old woman with heart failure was admitted to the hospital for IV diuresis. Her expected 1-year mortality is 43.1% according to a study. For men of the same age, the expected 1-year mortality is 37.9%.
Comparison of the efficacy and safety of new oral anticoagulants with warfari...Khairunnisa Zamri
This document summarizes a meta-analysis comparing the efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) to warfarin for preventing stroke in patients with atrial fibrillation. The analysis pooled data from four randomized controlled trials involving over 100,000 patients. It found that the new oral anticoagulants were as effective or more effective than warfarin at reducing strokes and systemic embolisms, with similar or lower rates of major bleeding. However, they were associated with an increased risk of gastrointestinal bleeding compared to warfarin. The analysis concluded that the new oral anticoagulants provide an improved
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
The study examined the positive predictive value of inpatient and emergency department diagnostic codes for identifying outpatient cases of sudden cardiac death and ventricular arrhythmias in Medicaid and Medicare claims data. Medical records for a random sample of 100 inpatient encounters and 100 emergency department encounters coded with relevant diagnoses were requested and 58% were obtained. First-listed diagnostic codes correctly identified cases 85.3% of the time overall based on criteria in the medical records.
Negligence in Prescribe Drugs Cases (Amputation legs and hands)Nur Ain Atiqa Azeman
On August 18, 2003, Fritzgerald presented to the emergency room of RHD Memorial Medical Center in Dallas, Texas, complaining of abdominal pain, lack of appetite, nausea, vomiting, a history of reflux, and a history of a 30-pound weight loss. The admitting physician consulted with Dr. Richard Holmes, a general surgeon, who determined that Fritzgerald had a duodenal ulcer and needed surgery. Holmes discharged Fritzgerald pending further testing and, 11 days later on August 29, Holmes performed surgery. Fritzgerald tolerated the procedure well. Holmes started Fritzgerald on an antibiotic to prevent a post-surgical abdominal infection and said he expected Fritzgerald to remain in the hospital for about three to five days.
Fritzgerald appeared to be recovering until September 1. Early that morning, Fritzgerald developed a high fever and his blood pressure began to drop. The nursing staff called Holmes about Fritzgerald's condition, and Holmes ordered tests. Fritzgerald exhibited symptoms of systemic inflammatory response syndrome, or sepsis.
In other words, an infection was attacking his entire body. By late evening of September 1, Fritzgerald's condition had deteriorated to septic shock, meaning his organs were not getting adequately profused, and Fritzgerald was in a life-threatening condition. The hospitalist coordinating Fritzgerald's care consulted Prabhakar, an infectious disease doctor.
Prabhakar first saw Fritzgerald around 10 p.m. on September 1. After reviewing all available data and examining the patient, Prabhakar believed Fritzgerald had peritonitis, which is an intra-abdominal infection. Mr.Prabhakar believe the infection could be related to the surgery, but the source of the infection was yet undetermined. Based on his clinical assessment of Fritzgerald's condition, Mr.Prabhakar ordered empiric antibiotic therapy-a broad spectrum antibiotic-to treat the most common pathogens that could cause the infection. The antibiotic therapy Prabhakar prescribed did not treat hospital-acquired Methicillin-Resistant Staphylococcus Aureus (MRSA). The antibiotic was started on the evening of September 1.
Other specialist physician also consulted on Fritzgerald's case, including a pulmonary critical care physician. They ordered numerous tests and chest x-rays, but none was able to determine the source of Fritzgerald's infection. Meanwhile, Fritzgerald's organs began to fail and his body diverted blood flow away from his extremities and to his vital organs through a process called vascular redistribution phenomenon. He was given a drug called Xigris to counteract this phenomenon and was transferred to the intensive care unit.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
Role of Noac (Newer oral aticoagulants) in covid 19 treatment Dr. JaykishanSingh45
1) NOACs have significant drug interactions with some antiviral medications used to treat COVID-19, whereas low molecular weight heparin and unfractionated heparin do not interact.
2) For hospitalized COVID-19 patients, low molecular weight heparin is preferred over NOACs for those admitted to the ICU or who are critically ill. NOACs, low molecular weight heparin, or unfractionated heparin can be used for non-ICU patients.
3) After discharge, extended anticoagulation may be recommended for high-risk COVID-19 patients, with rivaroxaban, apixaban, betrixaban, or enoxapar
Fabry Disease (FD), also known as Anderson-Fabry disease, is an inherited X-linked disorder characterized by the absence (in men) or defi ciency (in women) in α-galactosidase A, activity that causes a progressive accumulation of glycosphingolipids within lysosomes of cells in all the major organ systems and progressive organ damage that fi rst manifests in childhood or early adulthood. End Stage Renal Disease (ESRD) is a major cause of morbidity and premature mortality in FD. We present a male patient with FD who was transplanted with kidney from a living donor and had a sudden cardiac arrest on the 4th day after operation. We suggest detailed preoperative examination including coronary angiography, echocardiography for these patients and also a multidisciplinary care is required for perioperative management of FD patients.
The document discusses the role of the neurofibromin 1 (NF1) gene in cardiovascular development and disease. Key points:
1) Mice lacking the NF1 gene (Nf1-/-) die during embryonic development due to cardiovascular failure and defects in the heart.
2) The NF1 gene's GAP-related domain (GRD) helps regulate Ras signaling and rescues the lethal heart defects seen in Nf1-/- embryos when expressed.
3) However, mice completely rescued from the Nf1 deletion still die shortly after birth, showing the gene is critical for postnatal cardiovascular function.
Heparin-Induced Thrombocytopenia (HIT) is a highly prothrombotic disorder mediated by strong platelet-activating antibodies against multi molecular complexes of platelet factor4 and heparin, leading to consumptive thrombocytopenia and potentially devastating thromboembolic complications. Three alternative anticoagulants have been approved for the treatment of HIT: lepirudin, argatroban, and danaparoidsodium. We present a case of multiple organ embolism secondary to heparin-induced thrombocytopenia after IABP insertion in a cardiac shock secondary to acute myocardial infarction and our fi rst experience with the use of a novel oral anticoagulant, rivaroxaban, to treat a case of HIT-associated thrombosis after IABP insertion.
The document summarizes clinical trials investigating the oral anticoagulant Xarelto for the treatment and prevention of venous thromboembolism (VTE) and arterial thromboembolism. It describes two major studies:
1) The ROCKET AF study found that once-daily Xarelto was non-inferior to warfarin for preventing strokes in atrial fibrillation patients, with lower rates of intracranial bleeding and fatal bleeding.
2) The ATLAS ACS 2-TIMI 51 study found that adding 2.5 mg twice-daily Xarelto to standard antiplatelet therapy after an acute coronary syndrome reduced the composite of cardiovascular death, heart attack, and
Ponencia presentada por el Dr. Josep Comín Colet en el directo ‘IC preservada y resultados del PARAGON-HF’, realizado en la Casa del Corazón el 9 de septiembre de 2019.
This document summarizes several studies related to sacubitril/valsartan (LCZ696):
- The TRANSITION trial found that initiating sacubitril/valsartan in hospital shortly after stabilization from acute heart failure had similar safety outcomes as initiating post-discharge. About 50% of patients achieved the top dose within 10 weeks.
- The PIONEER-HF trial showed that among patients hospitalized for acute heart failure, sacubitril/valsartan led to a greater reduction in NT-proBNP levels at 8 weeks compared to enalapril, with similar rates of adverse events.
- The landmark PARADIGM-HF trial demonstrated that sacubitril
This document appears to be a collection of citations and snippets of text from various medical journal articles and publications. The articles discuss topics related to renal physiology including potassium regulation and excretion, mechanisms of hypertension, genetic disorders involving ion transporters, and case studies of patients presenting with hypokalemia, metabolic alkalosis, and other electrolyte abnormalities. Copyright information is provided for most entries.
Clopidogrel is a pro-drug that requires hepatic metabolism to become active. It is a cornerstone of treatment for acute coronary syndrome (ACS) as dual antiplatelet therapy with aspirin. The CURE trial showed clopidogrel plus aspirin reduces cardiovascular events in ACS patients compared to aspirin alone. Later trials like CREDO found clopidogrel reduces events in patients post-percutaneous coronary intervention compared to aspirin. Newer P2Y12 inhibitors like prasugrel and ticagrelor are more effective at preventing ischemia but with increased bleeding risk. De-escalating dual antiplatelet therapy from newer drugs to clopidogrel appears safe and effective.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Quel enseignement du fait religieux ? (Dominique Santelli)
Session nationale de l'Enseignement Catholique sur l'enseignement du fait religieux.
http://icm.catholique.fr
This document presents a recurring theme over two centuries where new technologies in education are criticized for making students too dependent or replacing important basic skills. Quotes from 1703 to 1950 criticize slates, paper, ink, pens, fountain pens, ballpoint pens and calculators for replacing traditional tools like bark, slate, sharpening pencils and making ink. The final quote from 1985 criticizes calculators and a concluding statement notes we still use older tools but now computers which will likely face similar criticisms of enabling dependence.
This document discusses open education initiatives at Delft University of Technology. It describes how open online courses (MOOCs), open courseware (OCW), and online distance education provide educational resources and opportunities. Open education allows people worldwide to access top-quality education from TU Delft. It supports lifelong learning and accommodates more students. While OCW and MOOCs offer free course materials, online distance education provides accredited certificates and degrees for enrolled students.
This document outlines a company's plan to enter the Russian market. It provides background on the company and an analysis of Russia's market potential. The proposed strategy includes establishing sales offices in Moscow and Yekaterinburg in the short term, and potentially storage facilities and production in Russia in the long term. The company will use trade shows, catalogs, and websites for advertising and distribute products directly to business customers from Germany in the first 5 years.
Mustard oil is generally considered heart healthy due to its low saturated fat content. However, it contains high levels of erucic acid, which studies have shown can damage heart muscles in large quantities. Tilapia fish also contains high levels of omega-6 fatty acids compared to omega-3, with ratios as high as 20:1. This imbalance promotes inflammation and heart disease more than red meat like bacon or hamburgers. While fish is typically recommended for a heart healthy diet, tilapia should be avoided due to its fatty acid profile.
1) The document discusses antiplatelet therapy for Asian patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI), specifically comparing ticagrelor and clopidogrel.
2) The PLATO trial showed ticagrelor reduced cardiovascular events compared to clopidogrel in ACS patients but increased major bleeding risks. However, the PHILO trial of ticagrelor vs clopidogrel in Asian ACS patients found no difference in cardiovascular outcomes or major bleeding.
3) Guidelines recommend balancing bleeding risks with potential benefits when choosing antiplatelet therapy for Asians, as they may have a different therapeutic window than Caucasians. De-escalating or switching
Hypertension and HTPR (high on treatment platelet reactivity measured by aggr...Dragana Sarenac
1) There are studies showing connections between hypertension and changes in platelet size, volume, and reactivity. Hypertension may influence the pathophysiology of cardiovascular events through effects on platelets.
2) L-arginine supplementation has potential as a strategy for preventing coronary artery disease, as hypertension is connected to reduced L-arginine availability and nitric oxide production in platelets. However, evidence for this is currently only from experimental animal studies.
3) More studies are needed to specifically consider the connection between hypertension and high on-treatment platelet reactivity (HTPR) measured by platelet function tests like aggregometry.
REVIEW ARTICLE SEPTEMBER 2021 medical.pptxArunDeva8
This document summarizes the evolving use of biomarkers in the management of heart failure. It discusses how biomarkers such as BNP, NT-proBNP, cTn, ST2, and galectin-3 can be used to diagnose heart failure, establish disease prognosis and severity, and predict patient outcomes. Elevated levels of these biomarkers are associated with worse symptoms and higher mortality in heart failure patients. The document also presents a case study of an elderly male patient presenting with heart failure symptoms and discusses the clinical implications of his elevated BNP and cTnT biomarker levels.
Dr. José Luis Ferreiro presented on the incorporation of cangrelor as the newest addition to antiplatelet treatment in PCI. Cangrelor is a direct-acting, reversible P2Y12 inhibitor administered intravenously with an extremely short half-life. Clinical trials demonstrated cangrelor reduced death, MI, ischemia-driven revascularization and stent thrombosis within 48 hours compared to clopidogrel in PCI patients who had not received a pre-treatment P2Y12 inhibitor. Guidelines recommend cangrelor for high-risk PCI when no pre-treatment with a P2Y12 inhibitor is possible. Transition from cangrelor to oral agents requires caution due to a potential gap in platelet
Phenytoin is an effective treatment for focal epilepsy and was also used as an antiarrhythmic drug. It acts as a sodium channel blocker and can lower blood pressure through vasodilation effects. Phenytoin has antiarrhythmic properties but may cause bradycardia, arrhythmias, and asystole in high doses or rapid infusion rates. It should be administered cautiously in patients with cardiovascular conditions and given at slow infusion rates.
The document discusses oxidation, disease reversal, and cellular metabolism. It explains that oxidation leads to breakdown at the cellular level and causes disease, while proper metabolism supports cellular buildup and regeneration for health. Maintaining reduced oxidation and optimal metabolism can reverse disease by supporting healthy cellular function and structure replacement at rates up to 1 million new cells per day. Factors like diet, pollution, and lifestyle choices can increase or decrease oxidation levels and affect health and disease.
This document discusses antiplatelet medications used for neurointerventional procedures. It begins by covering platelet physiology and the mechanisms of common antiplatelet drugs. It then addresses the use of antiplatelets as prophylaxis for procedures, noting evidence that aspirin alone or aspirin with clopidogrel are commonly used. For complex cases, prasugrel or ticagrelor may be alternatives. The document also reviews using antiplatelets as rescue therapies, finding glycoprotein IIb/IIIa inhibitors safer than fibrinolytics. Overall, the document evaluates evidence on optimizing antiplatelet regimens to reduce thromboembolic risks during and after neurointerventions.
Relapsing Urinary Catheter Bleeding with Triple Antithrombotic Therapy in an ...CrimsonPublishersAICS
Relapsing Urinary Catheter Bleeding with Triple Antithrombotic Therapy in an Elderly Patient with ACS, PCI and A-fib: A Case Report by Michael AB Naafs* in Advancements in Case Studies
1) Telmisartan is advantageous over ACE inhibitors for patients with cardiovascular risk as it provides renin-angiotensin system blockade with fewer side effects and better treatment adherence, leading to reduced cardiovascular risk.
2) Telmisartan more effectively controls blood pressure throughout the 24-hour dosing period compared to ramipril, including better control of the early morning blood pressure surge which is important for reducing cardiovascular risk.
3) High adherence to antihypertensive treatment is associated with a 10% reduced risk of coronary artery disease, so assessing and supporting adherence is important for primary prevention of CAD in hypertensive patients.
The document summarizes a journal presentation comparing the efficacy and safety of new oral anticoagulants (NOACs) to warfarin for stroke prevention in atrial fibrillation patients. It provides background on atrial fibrillation and an overview of 4 large randomized controlled trials evaluating dabigatran, rivaroxaban, apixaban, and edoxaban. A meta-analysis of these trials found NOACs reduced the risk of stroke and systemic embolism by 19% and lowered mortality compared to warfarin, while increasing gastrointestinal bleeding but decreasing intracranial hemorrhage. NOACs showed consistent benefits across patient subgroups.
Pakistan Pharma Career Door Newsletter ,Issue 4, Volume 4Javeriya_PPCD
The European Medicines Agency's Committee on Medicinal Products for Human Use (CHMP) has recommended granting marketing authorization for Trimbow (Chiesi Farmaceutici S.p.A., Italy), a combination of three inhaled medications, for the maintenance treatment of adults with moderate to severe chronic obstructive pulmonary disease (COPD) who do not respond adequately to a combination of an inhaled corticosteroid and a long-acting β2-agonist. Trimbow contains beclometasone dipropionate, formoterol fumarate dihydrate, and glycopyrronium bromide to reduce lung inflammation, relax bronchial smooth muscle and dilate the airways. The triple-
The TWILIGHT trial compared ticagrelor monotherapy to ticagrelor plus aspirin in patients at high risk of bleeding and ischemic events after PCI. Over 7,000 patients received ticagrelor and aspirin for 3 months after PCI. Then patients were randomized to ticagrelor alone or with aspirin for 12 more months. The study found ticagrelor monotherapy was associated with a 44% lower risk of bleeding over 1 year without increasing ischemic events, suggesting it may be a safer option for high risk patients after a brief initial period of dual antiplatelet therapy.
Role of antiplatelets in cardiovascular diseases.pptxMohamedSabry35679
The document summarizes information about antiplatelet drugs, including their definition, mechanism of action, role in different diseases, and major clinical trials. Antiplatelet drugs prevent and inhibit platelet activation and aggregation to interfere with thrombus formation. The principal classes are cyclooxygenase inhibitors like aspirin, and P2Y12 receptor blockers that inhibit the ADP pathway such as clopidogrel, prasugrel, and ticagrelor. Major trials like CAPRIE, CHARISMA, and Prevention of Cardiovascular Events compared antiplatelet regimens in coronary diseases and found some regimens reduced events more than aspirin alone with increased bleeding risks. Optimal medical therapy alone was found sufficient
The document discusses intensive antiplatelet therapy for acute coronary syndrome (ACS) from the acute to chronic phase. It provides guidelines for treatment strategies and timing according to risk stratification for non-ST-segment elevation ACS. It recommends dual antiplatelet therapy (DAPT) with a P2Y12 receptor inhibitor plus aspirin for 12 months after stent implantation for NSTE-ACS, unless there is a high risk of bleeding. For patients at high risk of ischemic events and low bleeding risk, extending DAPT beyond 12 months may be considered.
A 59-year-old man presented with sudden onset headache, mild dysmetria, and severe nausea. A CT scan showed a left paramedian cerebellar hemorrhage measuring 29 × 18 mm with partial effacement of the fourth ventricle. The man had a medical history of coronary artery disease, hypertension, and hyperlipidemia. The case discusses the use of dual antiplatelet therapy (DAPT) of aspirin and an oral P2Y12 inhibitor such as clopidogrel or ticagrelor following acute coronary syndrome (ACS) to prevent stent thrombosis and other adverse cardiovascular events beyond one year. Guidelines recommend DAPT for at least 12 months after ACS and consider risk
Thuốc điều trị tăng huyết áp trên bệnh thận đái tháo đường - BS Phạm Văn Bù...cacao83
This document discusses hypertension and its effects on the kidney. It provides an overview of key considerations in the pathophysiology of hypertension, including the roles of the renin-angiotensin-aldosterone system and other factors. Several studies are summarized that examine the use of diuretics and other antihypertensive drugs to control blood pressure and reduce proteinuria in patients with chronic kidney disease. Angiotensin receptor blockers are highlighted as effective treatments for slowing the progression of kidney disease through blood pressure control and additional renoprotective effects.
Hypertension is a major public health issue and leading cause of cardiovascular disease globally. It is responsible for about half of heart disease and stroke deaths. The number of hypertensive individuals in India is expected to nearly double by 2025. Chronic kidney disease (CKD) is a major complication of hypertension, with hypertension being the primary cause of end stage renal disease. Strict blood pressure control and use of renin-angiotensin system inhibitors are important for slowing the progression of CKD and reducing proteinuria. Calcium channel blockers, particularly non-dihydropyridine types like cilnidipine, have beneficial effects on renal function through reduction of intraglomerular pressure and antioxidant properties independent of blood pressure
WHAT IS NEW IN MEDICINE TODAY?
Bangladesh Academy of Family Physicians organizes continuing medical education (CME) program last Friday of each month during 9AM to 12 noon. Part of this CME program is a 15-20 minutes presentation on "What is new in medicine today?" This presentation is prepared and presented exclusively by me.
To prepare this presentation I need to go through number of journals, recently released guidelines etc., collect specific information regarding newest researches and present.
Management Of Obesity In Family Practice Cme 30 May08Gauranga Dhar
The document discusses obesity management in family practice. It defines obesity as a BMI of 30 kg/m2 or higher and notes that obesity is now a global epidemic according to the WHO. The management of obesity involves assessment to determine the degree and overall health status, followed by management focusing on weight loss, weight maintenance, and controlling other risk factors like cardiovascular disease and diabetes. Lifestyle and diet changes, physical activity, and behavior modification are emphasized as the primary non-pharmacological treatment approaches.