Credit: Original article published here.There are no solutions, only tradeoffs. In acute myocardial infarction, we have tradeoffs between coronary supply and myocardial demand. In terms of supply, we have made significant progress by reducing ischemic time but see a plateau of benefit at 90 minutes. In terms of demand, we currently utilize pharmacotherapy which may be too little too late, especially in patients with large infarct size who have progressed to cardiogenic shock and cannot tolerate these therapies. We see these trends in the outcomes data. While advances in restoring supply have led to high short-term survival rates, long-term outcomes remain challenging due to the incidence of heart failure which reaches nearly 75% at 5 years (1). In-hospital mortality for cardiogenic shock remains abysmal despite advances in reperfusion. Thus, it is paramount that we find therapies capable of limiting infarct size without compromising systemic perfusion. Mechanical unloading is one option that has been shown to reduce infarct size in preclinical studies since the 1980s. Translating the efficacy of preclinical studies to effectiveness in the real world, however, remains a work in progress. The initial roadblock was inadequate technology. In 2008, the FDA approved the Impella, a percutaneous transaxial flow pump,

Credit: Original article published here.The implantable cardioverter defibrillator (ICD) is frequently utilized in patients with heart failure for primary and secondary prevention and treatment of unstable arrhythmias. This device is a unique medical intervention that may improve survival for select patients but does not necessarily improve quality of life and may even lead to detrimental impacts. At the 2023 Houston Shock Symposium, Dr. Haider Warraich – director of the heart failure program at VA Boston Healthcare, assistant professor at Brigham and Women’s Hospital and prolific author highlighted the psychological stress that can impact ICD recipients and the physician role in addressing these stressors with our patients. Psychological stressors can present in many ways in ICD recipients; ranging from feeling phantom shocks to avoiding engagements due to fear of shock and persistent hyper-vigilance. Identified risk factors for increased psychosocial distress in ICD recipients include younger age less than 50 years old, female gender, low social support, premorbid psychiatric diagnosis, and greater than 5 appropriate or inappropriate defibrillations.1 Dr. Warraich challenged healthcare providers at the Houston Shock Symposium to consider the physician role in empowering patients to shift their mindset after an ICD shock from victimhood thinking with poor coping skills to

Credit: Original article published here.The following question refers to Section 4.6 of the 2021 ESC CV Prevention Guidelines. The question is asked by StudentDr. Shivani Reddy, answered first by Johns Hopkins Cardiology FellowDr. Rick Ferraro, and then by expert facultyDr. Eileen Handberg. Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President for the PCNA. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelinesrepresents a collaboration with theACC Prevention of CVD Section, theNational Lipid Association, andPreventive Cardiovascular Nurses Association. Question #22 Mr. HC is a 50-year-old man presenting for a routine clinic visit. He is not sure the last time he had a lipid panel drawn, and would like one today, but ate lunch just prior to your appointment – a delicious plate of 50% fruits and vegetables, 25% lean meats, and 25% whole grains as you had previously recommended. True or False: Mr. HC should return another day to obtain a fasting lipid panel.

Credit: Original article published here.The following question refers to Sections 11.3 of the2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Western Michigan University medical student and CardioNerds InternShivani Reddy, answered first by Johns Hopkins Osler internal medicine resident and CardioNerds Academy FellowDr. Justin Brilliant, and then by expert facultyDr. Harriette Van Spall. Dr. Van Spall is Associate Professor of Medicine, cardiologist, and Director of E-Health at McMaster University. Dr Van Spall is a Canadian Institutes of Health Research-funded clinical trialist and researcher with a focus on heart failure, health services, and health disparities. TheDecipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failureseries was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds CofoundersDr. Amit GoyalandDr. Dan Ambinder, with mentorship fromDr. Anu Lala,Dr. Robert Mentz, andDr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #16 Ms. Augustin

Credit: Original article published here.There is increasing recognition that left ventricle (LV) unloading is important for patients in cardiogenic shock supported by venous-arterial extracorporeal membrane oxygenation (VA-ECMO) – particularly, those in shock due to acute myocardial infarction (CS-AMI).1 Unloading the LV is commonly performed by inserting additional temporary mechanical circulatory support (tMCS), including devices like a percutaneous left ventricular assist device (pVAD, i.e., Impella®), CentriMag®, or an intra-aortic balloon pump.2 One approach to unload the LV during VA-ECMO that is infrequently used involves placement of a left-atrial drainage catheter that is placed via interatrial transseptal puncture. This would allow for direct left atrial drainage, thereby reducing pulmonary capillary wedge pressure and left ventricular preload thereby unloading the LV. This strategy is described as left atrial VA-ECMO or “LAVA-ECMO”. During the 2023 Houston Shock Symposium, Dr. William W. O’Neill presented a case report about a patient with severe aortic regurgitation resulting in cardiogenic shock requiring the use of LAVA-ECMO as a bridge to definitive repair. Dr. Jeffrey Wang had a poster presentation on a case report on a patient with refractory cardiogenic shock initially cannulated with VA-ECMO as a bridge to heart transplant. However, the patient developed worsening pulmonary edema requiring

Credit: Original article published here. The CardioNerds Academy welcomes Dr. Melanie Sulistio to give the 2nd Annual Sanjay V. Desai Lecture in Medical Education to mark the graduation of the 2022 CardioNerds Academy Class. Join us as Dr. Sulistio and CardioNerds Academy Program Director Dr. Tommy Das discuss the humanity deficiency in medicine, and how the practice of compassionate assumption can lead us to be better physicians for our patients, our colleagues, our learners, and ourselves. Credit to rising CardioNerds Academy chiefs Dr. Rawan Amir, Dr. Kate Wilcox, Dr. Alaa Diab, and Dr. Gurleen Kaur for their terrific acting in this episode. Audio editing byCardioNerds academy intern,Pace Wetstein. Dr. Sanjay V Desai serves as the Chief Academic Officer, The American Medical Association and is the former Program Director of the Osler Medical Residency at The Johns Hopkins Hospital. Dr. Melanie Sulistio is an Associate Professor of Medicine in the Division of Cardiology at the University of Texas Southwestern. Additionally, she is an Associate Dean for Student Affairs and Distinguished Teaching Professor at the University of Texas Southwestern Medical School and co-chairs the ACC Internal Medicine Residency Program. She has a passion for medical education and promoting humanity in medicine, and

Credit: Original article published here. CardioNerds join Dr. Samid Muhammad Farooqui, Dr. Hiba Hammad, and Dr. Syed Talal Hussain, from the University of Oklahoma Pulmonary and Critical Care Medicine Fellowship Program, in Oklahoma City. The fellows will take us in a fascinating discussion of a case of rapidly progressing dyspnea and pulmonary hypertension in a patient with metastatic breast cancer. They will then reveal an interesting etiology ofpulmonary hypertension, wherethe secret was on the wedge! University of Oklahoma faculty and expert in pulmonary hypertension and right ventricular physiology, Dr. Roberto J. Bernardo provides theE-CPRfor this episode. Audio editing byCardioNerds Academy Intern,Dr. Christian Faaborg-Andersen. A septuagenarian female, with a past medical history of metastatic breast adenocarcinoma, presented to the hospital with worsening dyspnea over a period of 3 weeks. She was found to be in rapidly progressive hypoxic respiratory failure with unremarkable chest x-ray, CTA chest, and V/Q scan. Transthoracic echocardiogram revealed elevated RVSP and a subsequent right heart catheterization showed pre-capillary pulmonary hypertension with a low cardiac index. She was treated for rapidly progressive RV dysfunction with inotropic support and inhaled pulmonary vasodilators until she decided to pursue comfort measures. Wedge cytology came back positive for malignant cells, confirming a

Credit: Original article published here.CardioNerds correspondents Drs. Shiva Patiolla and Jeff Wang are covering The Houston Shock Symposium 2023. They are joined by the founder and director of the Houston Shock Symposium, Dr. Marwan Jumean, and Dr. Anju Bhardwaj, who currently serves as an assistant professor of medicine in the section of cardiology at the McGovern Medical School. The group discusses the theme of this year’s symposium, which is Breaking Boundaries, and will focus on the five areas of cardiogenic shock management, which are: Cardiac ICU, Cath Lab, Medical ICU, Operating Room, and Surgical ICU. See what these thought leaders had to say! Dr. Shiva Patiolla: Hello, everyone and thank you for joining us today. I am Shiva Patiolla. I’m a cardiology fellow at Baylor University Medical Center in Dallas, Texas, and a CardioNerds FIT Trialist. Dr. Jeff Wang: All right. Hi, everyone. My name is Jeff Wang, and I am a cardiology fellow at Emory University and a CardioNerds FIT Trialist as well. And we are really excited to serve as CardioNerds Conference Scholars for the 2023 Houston Shock Symposium with mentorship from Dr. Andrew Higgins. Dr. Shiva Patiolla: It is our great pleasure to be joined by the

Credit: Original article published here.The following question refers to Section 4.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by medicine resident Dr. Ahmed Ghoneem, and then by expert faculty Dr. Noreen Nazir. Dr. Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelinesrepresents a collaboration with theACC Prevention of CVD Section, theNational Lipid Association, andPreventive Cardiovascular Nurses Association. Question #21 Ms. J is a 57-year-old woman with a past medical history of myocardial infarction resulting in ischemic cardiomyopathy, heart failure with reduced ejection fraction, and major depressive disorder who presents today for follow-up. She reports feeling extremely overwhelmed lately due to multiple life stressors. She is on appropriate cardiovascular GDMT agents and is not prescribed any medications for her mood disorder. True or false: in addition to psychotherapy for stress management, it is appropriate to consider Ms. J for anti-depressant SSRI pharmacotherapy at this time to improve cardiovascular outcomes. A True B False Answer #21 Explanation The correct answer is

Credit: Original article published here.The following question refers to Section 10.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Western Michigan University medical student and CardioNerds Intern Shivani Reddy, answered first by Boston University cardiology fellow and CardioNerds Ambassador Dr. Alex Pipilas, and then by expert faculty Dr. Ileana Pina.Dr. Pina is Professor of Medicine and Quality Officer for the Cardiovascular Line at Thomas Jefferson University, Clinical Professor at Central Michigan University, and Adjunct Professor of Biostats and Epidemiology at Case Western University. She serves as Senior Fellow and Medical Officer at the Food and Drug Administration’s Center for Devices and Radiological Health.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds