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 4.4 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.According to Dua Abedeen, MPH, and colleagues at SUNY Downstate Health Sciences University, Brooklyn, New York, undue financial stress may force patients to choose between medication and other living expenses, resulting in inferior rates of medication adherence. Unless directly asked, patients may not disclose issues with finances to their provider. Using a Likert scale survey, the researchers interviewed a random convenience sample of 24 patients receiving dialysis and 16 kidney transplant recipients in an inner-city area. Results of the interviews were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled Association of Financial Stressors With Medication Nonadherence in Inner-City Patients With ESKD. Mean age of the interviewed patients was 59 years, 77% (n=30) identified as Black, 70% (n=26) were men, 57% (n=20) had less than a college education, and 65% (n=13) made less than $40,000 per year. Mean dialysis vintage was 5.2 years, and mean time since transplant was 4.0 years. All of the patients had insurance. More than half of the cohort (52%, n=19) said that finances affected their ability to control their medical condition, 42% (n=15) said they had difficulty meeting monthly bills, and 40%

Credit: Original article published here.At the 2nd annual THT 2023 conference, experts discussed what’s known and what’s cooking in the area of left ventricular unloading and myocardial recovery. Dr. Douglas Mann from Washington University School of Medicine in St. Louis set the stage with a ten-minute deep dive into the physiology of ventricular load. After a recall of the principles of the Frank-Starling curve for the audience, a discussion of the different molecular level signal transduction patterns that occur as a result of increasing load/stress of the myocytes eventually leading to cardiac hypertrophy, ensued. He elaborated upon the stretch activated pathways including Integrins, transient receptor potential (TRP) channels and sodium hydrogen exchanger (NHE) implicated in cardiac hypertrophy. Dr. Stravos Drakos from University of Utah Health Sciences Center followed with a review of the results of the RESTAGE-HF trial challenging the prevailing dogma “The failing human heart cannot improve after severe injury”. Guided by predictors of response before LVAD implantation, myocardial recovery incidence of up to 50% is achievable! He emphasized that reverse remodelling after LVAD is not “all or none” with 10% being responders, 30% partial responders and 60% non-responders. He raised the important question of sustainability after LVAD weaning

Credit: Original article published here.The 2023 sessions of Technology and Heart Failure Therapeutics (THT2023) took place on March 20-22nd, 2023 in Boston with great enthusiasm in technologies that are in the pipeline and amazing discussions about ongoing trials that will shape the future of our clinical practice. One of the most striking sessions was “Unloading in AMI: Changing the paradigm from DTB to DTU” presented by Dr. Navin Kapur. He talked about unloading the left ventricle in anterior MI prior to reperfusion to prevent myocardial injury. Since the 1970’s, acute management of ST elevation myocardial infarction has focused on timing of revascularization to prevent myocardial injury (MI). In the light of benefits shown in multiple studies, timely revascularization with balloon angioplasty followed with stenting remained as the standard of care. Despite significant improvements in health care systems to meet the Door-to-balloon time (DTB) of 90 minutes or less, heart failure continues to be an important issue. Approximately 35% of new in-hospital heart failure events in patients older than 65 years of age happen within the context of their first acute MI. In 2013, Navin Kapur et al. sought to answer the question if unloading the left ventricle while delaying coronary

Credit: Original article published here.In this episode, which rounds out the cytopenias series: The Fellow on Call team details the ins and outs of neutropenia. They break down why neutropenia is dangerous, and stress that in managing neutropenia, history is key. They also explain how to characterize neutropenia, and provide both common and uncommon causes of it.

Credit: Original article published here.Continuing on the journey their disease-specific lung cancer series: The Fellow of Call group dive into the “meat and potatoes” of non-small cell lung cancer (NSCLC) – how to treat it. They stress the importance of approaching every case in a stepwise fashion, while setting a goal to getting the patient into surgery to remove the cancer whenever it’s a viable option. On the topic of surgery, The Fellow on Call delves into, among other things, different options, or types of lung cancer surgery, and the ideal approach for adjuvant chemotherapy in NSCLC.