Cardiology
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A Review of Updated Guidelines Regarding Bradycardia and Cardiac Conduction Delay
The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society have established updated guidelines on the evaluation and management of patients with bradycardia and conduction delays. Many key elements remain largely unchanged from prior guideline recommendations on pacemakers published in 2008 and 2012, but there also are important new definitions, recommendations, and areas of emphasis.
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Early Identification of Cardiac Amyloidosis in Carpal Tunnel Surgery Patients
In a cohort of older patients undergoing carpal tunnel release surgery, an analysis of tenosynovial tissue revealed amyloid deposits in 10% of patients. This development may facilitate early diagnosis of cardiac amyloidosis.
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Mitral Annulus Disjunction and Ventricular Arrhythmias
A patient cohort with mitral annular disjunction (MAD) identified by echo was characterized clinically and by MRI. Ventricular arrhythmias were common in MAD patients and related to the degree of MAD and papillary muscle fibrosis by MRI but not the presence of mitral valve prolapse.
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Detection of Prosthetic Heart Valve Endocarditis
A multicenter, retrospective, observational study of patients undergoing 18F-fluorodeoxyglucose PET/CT for prosthetic valve endocarditis or other indications showed that if certain obvious confounders are excluded, this imaging technique offers a high degree of accuracy for diagnosing prosthetic valve endocarditis, especially if performed early in the course of the disease.
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Study Adds Complexity to Post-TAVR Anticoagulation
In this large contemporary, prospective transcatheter aortic valve replacement registry, oral anticoagulation appears to be protective against valve degeneration but is associated with increased mortality. The strongest predictors of mortality at three years were male gender, renal failure, and atrial fibrillation.
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Finding a Consensus on ARDS Diagnostics and Determining a Relationship to Hospital Mortality
Critical care physicians reviewed more than 700 mechanically ventilated patients with acute hypoxemia and reached a consensus on the presence of acute respiratory distress syndrome (ARDS) in 15% of patients and nonconsensus on the presence of ARDS in an additional 14% of cases. Hospital mortality was not different between these cohorts (37% and 35%, respectively).
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Preventive Tactics and Management of Acute Kidney Injury in the ICU
Acute kidney injury (AKI) is a sudden decline in renal function due to nephron dysfunction and/or damage that results in nitrogenous waste product accumulation and acid-base, electrolyte, and fluid disturbances. It is estimated to occur in 16-67% of critically ill patients admitted to the ICU. Common inciting causes include major surgery, iatrogenic interventions, and sepsis. Advanced age and comorbidities increase kidney susceptibility to various exposures and insults. Severe AKI requiring renal replacement therapy (RRT) is associated with a 10-fold increase in mortality and increases length of stay an average of 5.7 days. Preventive tactics and RRT remain the cornerstones of AKI management in critically ill patients.
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Identify 4 Major Findings in New-onset Chest Pain Patient
The ECG in the figure was obtained from a patient with new-onset chest pain. He was hemodynamically stable at the time the tracing was obtained. In addition to the artifact that is most pronounced in the lateral chest leads, there are four major findings. Admittedly, two findings are subtle. How many findings can you identify?
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Human Papillomavirus Vaccine (Gardasil 9)
The FDA has approved a supplemental application to expand the indication for human papillomavirus 9-valent vaccine (HPV-9) to include men and women 27-45 years of age.
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Who Really Needs Intensive Blood Pressure Control?
A patient baseline characteristics level analysis of the SPRINT and ACCORD trials resulted in the creation of a simple algorithm for identifying high-risk patients who experienced fewer major cardiac events without increased serious adverse events from intensive blood pressure therapy.