Wednesday May 30, 2007
Digoxin Toxicity
Q: Once patient receive Digoxin Fragmented Antibody (DIGIFAB or Digibind), how frequent digoxin level should be measured ?
A: Digoxin level after giving Digibind will rise and will remain distorted for about 7 days. This is due to ability of Digibind to pull all of the digoxin into blood stream. These are inactive fragments and not toxic. There is no need to follow Dig level after administration of Digibind as it will be erroneously high and misleading.
Showing posts with label cardiovascular. Show all posts
Showing posts with label cardiovascular. Show all posts
Wednesday, May 30, 2007
Sunday, May 20, 2007
Sunday May 20, 2007
Free International Cardiology Internet Congress
Registration to participate in the the Fifth Virtual Congress of Cardiology - QCVC, organized by the Argentine Federation of Cardiology - is now open. The Congress will take place from September 1st to November 30th, 2007. The Argentine Federation of Cardiology - FAC organizes every two years, International Congresses of Cardiology by the Internet. They are characterized by a high scientific level and low cost for participants.
In last Virtual Congress of Cardiology (2005) 18,185 registrants from 128 countries participated. Access to the Fifth Virtual Congress of Cardiology will be made by a simple connection to the Internet. The lectures, reports, abstracts and brief communications will be published in Web pages. Opinions and questions will be sent by e-mail to discuss the respective forums and there will be on-line discussions in real time by scheduled chats. Everything that is treated in the Congress will remain permanently published on the Web. The Newsletter (Spanish, Portuguese, and English) will be edited weekly and sent to all the registrants throughout the three months of the Congress.
Click here to register or visit http://www.fac.org.ar/qcvc
Congress will have 21 thematic Units
Free International Cardiology Internet Congress
Registration to participate in the the Fifth Virtual Congress of Cardiology - QCVC, organized by the Argentine Federation of Cardiology - is now open. The Congress will take place from September 1st to November 30th, 2007. The Argentine Federation of Cardiology - FAC organizes every two years, International Congresses of Cardiology by the Internet. They are characterized by a high scientific level and low cost for participants.
In last Virtual Congress of Cardiology (2005) 18,185 registrants from 128 countries participated. Access to the Fifth Virtual Congress of Cardiology will be made by a simple connection to the Internet. The lectures, reports, abstracts and brief communications will be published in Web pages. Opinions and questions will be sent by e-mail to discuss the respective forums and there will be on-line discussions in real time by scheduled chats. Everything that is treated in the Congress will remain permanently published on the Web. The Newsletter (Spanish, Portuguese, and English) will be edited weekly and sent to all the registrants throughout the three months of the Congress.
Click here to register or visit http://www.fac.org.ar/qcvc
Congress will have 21 thematic Units
- Arrhythmias and Electrophysiology
- Basic Research
- Bioengineering - Medical Informatics
- Cardiomyopathy
- Cardiovascular Interventionism
- Cardiovascular Nursing
- Cardiovascular Pharmacology
- Cardiovascular Surgery
- Cerebral and Peripheral Vascular Diseases
- Chagas' Disease
- Echocardiography
- Epidemiology and Cardiovascular Prevention
- Genetics
- Heart Failure
- Hypertension
- Ischemic Heart Disease
- Nuclear Cardiology
- Pediatric Cardiology
- Sports Cardiology
- Technicians in Cardiology
- Transdisciplinary Cardiology
Wednesday, May 16, 2007
Wednesday May 16, 2007
Right or biventricular ventricular assist device (RVAD or BiVAD)
Continuing our theme from yesterday on LVAD , Right Ventricular assist device (RVAD) provide support for failed right ventricle and connects it to pulmonary artery. Another extreme is to provide support to both ventricles simultaneously and its called BiVAD or Biventricular assist device.
Related: See Video Dr. Dow's pump from Dr. Cohen at Texas Heart Institute, Houston - also describing mechanism of presently used pulsatile and centrifugal (continuous) VADs.
Right or biventricular ventricular assist device (RVAD or BiVAD)
Continuing our theme from yesterday on LVAD , Right Ventricular assist device (RVAD) provide support for failed right ventricle and connects it to pulmonary artery. Another extreme is to provide support to both ventricles simultaneously and its called BiVAD or Biventricular assist device.
Related: See Video Dr. Dow's pump from Dr. Cohen at Texas Heart Institute, Houston - also describing mechanism of presently used pulsatile and centrifugal (continuous) VADs.
Tuesday, May 15, 2007
Tuesday May 15, 2007
What is Implantable left ventricular assist device (LVAD)
A ventricular assist device (VAD) is a mechanical pump that helps failed heart pump blood throughout the body. It was destined to used as a "bridge-to-transplant" but it is also a destined therapy for many patients who are not eligible for transplant. Actually, recently it has been reported that LVAD may reverse the heart failure by prolonged unloading of the myocardium causing myocardial recovery ! 1 There are many commercially type pumps available in market but basic idea is the same to help weak ventricle in pumping blood. There are 2 basic kinds available though - Pusatile and continuous (or debakey which is totally implanted inside the body). Parts consist of
1. A pump unit, implanted in the abdomen (very thin patients becomes ineligible)
2. An inflow tube (or conduit), attached to the bottom of the apex of left ventricle
3. An outflow tube, attached to the aorta Internal valves that allow for one-way blood flow through the system
4. Power leads, that pass from the internal device through the skin.
5. External controller and power base unit or battery pack that attaches to the power leads/cables.
The controller is programmed to maintain a specific pump spread. It displays the status of the system and sounds alarms if any. The controller and batteries can be worn in a belted waist pack or a holster under the arm. Or, it may be connected to a power base unit and plugged into a wall outlet.
References: click to get article / abstract
1. Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure - NEJM, Volume 355:1873-1884, November 2, 2006
What is Implantable left ventricular assist device (LVAD)
A ventricular assist device (VAD) is a mechanical pump that helps failed heart pump blood throughout the body. It was destined to used as a "bridge-to-transplant" but it is also a destined therapy for many patients who are not eligible for transplant. Actually, recently it has been reported that LVAD may reverse the heart failure by prolonged unloading of the myocardium causing myocardial recovery ! 1 There are many commercially type pumps available in market but basic idea is the same to help weak ventricle in pumping blood. There are 2 basic kinds available though - Pusatile and continuous (or debakey which is totally implanted inside the body). Parts consist of
1. A pump unit, implanted in the abdomen (very thin patients becomes ineligible)
2. An inflow tube (or conduit), attached to the bottom of the apex of left ventricle
3. An outflow tube, attached to the aorta Internal valves that allow for one-way blood flow through the system
4. Power leads, that pass from the internal device through the skin.
5. External controller and power base unit or battery pack that attaches to the power leads/cables.
The controller is programmed to maintain a specific pump spread. It displays the status of the system and sounds alarms if any. The controller and batteries can be worn in a belted waist pack or a holster under the arm. Or, it may be connected to a power base unit and plugged into a wall outlet.
References: click to get article / abstract
1. Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure - NEJM, Volume 355:1873-1884, November 2, 2006
Friday, May 11, 2007
Friday May 11, 2007
Hypokalemia and Hypertension !
Interesting article published this week in The New England Journal of Medicine: Sodium and Potassium in the Pathogenesis of Hypertension. Just to quote few lines from article:
"........Numerous studies show an adverse effect of a surfeit of sodium on arterial pressure. By contrast, potassium, the main intracellular cation, has usually been viewed as a minor factor in the pathogenesis of hypertension. However, abundant evidence indicates that a potassium deficit has a critical role in hypertension and its cardiovascular sequelae.......Population studies have shown an inverse relation of potassium intake to blood pressure, the prevalence of hypertension, or the risk of stroke.... After adjusting for potentially confounding variables, the INTERSALT (The International Study of Salt and Blood Pressure) researchers estimated that a decrease in potassium excretion by 50 mmol per day was associated with an increase in systolic pressure of 3.4 mm Hg and an increase in diastolic pressure of 1.9 mm Hg............ A high-potassium diet and increases in serum potassium, even within the physiologic range, cause endothelium-dependent vasodilatation by hyperpolarizing the endothelial cell through stimulation of the sodium pump and opening potassium channels....The central actions of changes in the concentrations of sodium and potassium in the cerebrospinal fluid and of an excess of sodium and a deficit of potassium in the body are probably mediated by changes in the activity of the neuronal sodium pump and the renin–angiotensin system in the brain. These changes alter sympathetic outflow, which then causes directional changes in blood pressure. Baroreceptor sensitivity is depressed by potassium depletion and restored by potassium supplementation.......In its 2002 advisory, the coordinating committee of the National High Blood Pressure Education Program identified both a reduction in dietary sodium and potassium supplementation as proven approaches for preventing and treating hypertension. The Institute of Medicine...also advises adults to consume at least 120 mmol of potassium per day (approximately 4.7 g of potassium per day, which is about twice the current U.S. average)......"
Reference: click to get abstract
Sodium and Potassium in the Pathogenesis of Hypertension - Volume 356:1966-1978 , May 10 2007
Hypokalemia and Hypertension !
Interesting article published this week in The New England Journal of Medicine: Sodium and Potassium in the Pathogenesis of Hypertension. Just to quote few lines from article:
"........Numerous studies show an adverse effect of a surfeit of sodium on arterial pressure. By contrast, potassium, the main intracellular cation, has usually been viewed as a minor factor in the pathogenesis of hypertension. However, abundant evidence indicates that a potassium deficit has a critical role in hypertension and its cardiovascular sequelae.......Population studies have shown an inverse relation of potassium intake to blood pressure, the prevalence of hypertension, or the risk of stroke.... After adjusting for potentially confounding variables, the INTERSALT (The International Study of Salt and Blood Pressure) researchers estimated that a decrease in potassium excretion by 50 mmol per day was associated with an increase in systolic pressure of 3.4 mm Hg and an increase in diastolic pressure of 1.9 mm Hg............ A high-potassium diet and increases in serum potassium, even within the physiologic range, cause endothelium-dependent vasodilatation by hyperpolarizing the endothelial cell through stimulation of the sodium pump and opening potassium channels....The central actions of changes in the concentrations of sodium and potassium in the cerebrospinal fluid and of an excess of sodium and a deficit of potassium in the body are probably mediated by changes in the activity of the neuronal sodium pump and the renin–angiotensin system in the brain. These changes alter sympathetic outflow, which then causes directional changes in blood pressure. Baroreceptor sensitivity is depressed by potassium depletion and restored by potassium supplementation.......In its 2002 advisory, the coordinating committee of the National High Blood Pressure Education Program identified both a reduction in dietary sodium and potassium supplementation as proven approaches for preventing and treating hypertension. The Institute of Medicine...also advises adults to consume at least 120 mmol of potassium per day (approximately 4.7 g of potassium per day, which is about twice the current U.S. average)......"
Reference: click to get abstract
Sodium and Potassium in the Pathogenesis of Hypertension - Volume 356:1966-1978 , May 10 2007
Thursday, May 10, 2007
Thursday May 10, 2007
What is Tandem Heart®
To support cardiac failure or to bridge the time till permanent solution found (cardiac surgery, heart transplant etc) various mechanical circulatory support systems have been used. Intraaortic balloon pump (IABP) is the most widely used measure but it is limited in its funtion due to support it provides and in its relatively shorter duration of use desired.
The Tandem Heart® Percutaneous Ventricular Assist Device (pVAD)™ system uses a transseptal cannula that allows direct unloading of the left heart at blood flow rates sufficient to sustain patients.
In TandemHeart a percutaneous catheter inserted at the right femoral vein, advanced upto right atrium, and under flouroscopy literally a hole is made in the interatrial septum (in the fossa ovalis). Next an arterial catheter inserted percutaneously into the right femoral artery (or two arterial catheters into both femoral arteries) and then advanced into the lower abdominal aorta. Catheters made connected to a centrifugal pump. Heparin is used continuously through the lubrication system of the device, adjusting the activated clotting time (maintained at 200 seconds).
The Tandem Heart has a low blood surface contact area, resulting in reduced potential for hemolysis and thromboemboli.
Data suggests it to be a promising technology and may become a regular feature in coronary care units. In references below, we are providing results from well done studies and bedside work.
References: click to get abstracts/articles
1. Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance - (Circulation. 2001;104:2917.)
2. Clinical Experience with the TandemHeart® Percutaneous Ventricular Assist Device - Tex Heart Inst J. 2006; 33(2): 111–115.
3. Temporary assist device for postcardiotomy cardiac failure - Ann Thorac Surg 2004;77:1431-1433
4. Left ventricular assist devices as permanent heart failure therapy: the price of progress.- Ann Surg. 2003 Oct;238(4):577-83; discussion 583-5
5. Percutaneous left ventricular assist device: "TandemHeart" for high-risk coronary intervention. - Catheter Cardiovasc Interv. 2005 Jul;65(3):346-52.
What is Tandem Heart®
To support cardiac failure or to bridge the time till permanent solution found (cardiac surgery, heart transplant etc) various mechanical circulatory support systems have been used. Intraaortic balloon pump (IABP) is the most widely used measure but it is limited in its funtion due to support it provides and in its relatively shorter duration of use desired.
The Tandem Heart® Percutaneous Ventricular Assist Device (pVAD)™ system uses a transseptal cannula that allows direct unloading of the left heart at blood flow rates sufficient to sustain patients.
In TandemHeart a percutaneous catheter inserted at the right femoral vein, advanced upto right atrium, and under flouroscopy literally a hole is made in the interatrial septum (in the fossa ovalis). Next an arterial catheter inserted percutaneously into the right femoral artery (or two arterial catheters into both femoral arteries) and then advanced into the lower abdominal aorta. Catheters made connected to a centrifugal pump. Heparin is used continuously through the lubrication system of the device, adjusting the activated clotting time (maintained at 200 seconds).
The Tandem Heart has a low blood surface contact area, resulting in reduced potential for hemolysis and thromboemboli.
Data suggests it to be a promising technology and may become a regular feature in coronary care units. In references below, we are providing results from well done studies and bedside work.
References: click to get abstracts/articles
1. Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance - (Circulation. 2001;104:2917.)
2. Clinical Experience with the TandemHeart® Percutaneous Ventricular Assist Device - Tex Heart Inst J. 2006; 33(2): 111–115.
3. Temporary assist device for postcardiotomy cardiac failure - Ann Thorac Surg 2004;77:1431-1433
4. Left ventricular assist devices as permanent heart failure therapy: the price of progress.- Ann Surg. 2003 Oct;238(4):577-83; discussion 583-5
5. Percutaneous left ventricular assist device: "TandemHeart" for high-risk coronary intervention. - Catheter Cardiovasc Interv. 2005 Jul;65(3):346-52.
Friday, May 4, 2007
Friday May 04, 2007
Scenario: You have been called to see a consult for a patient with mental status change and anasarca. On arrival you noticed a young man lying supine in bed with facial edema, upper extremity edema, lethargy, papilledema and neck veins visible. You suspect Superior Vena Caval Snydrome. What is the first thing you will do, may be even before start talking to patient ?
Answer: Have patient sit upright.
Patients with apparent clinical SVC syndrome gain significant symptomatic improvement from elevation of the head of the bed due to release of fluid pressure with gravity. It is a very benign maneuver but very significant for a patient as it provides dramatic relief of symptoms.
This week The New England Journal of Medicine has a nice writeup on Superior Vena Cava Syndrome with Malignant Causes - Volume 356:1862-1869, Number 18, May 3, 2007
Scenario: You have been called to see a consult for a patient with mental status change and anasarca. On arrival you noticed a young man lying supine in bed with facial edema, upper extremity edema, lethargy, papilledema and neck veins visible. You suspect Superior Vena Caval Snydrome. What is the first thing you will do, may be even before start talking to patient ?
Answer: Have patient sit upright.
Patients with apparent clinical SVC syndrome gain significant symptomatic improvement from elevation of the head of the bed due to release of fluid pressure with gravity. It is a very benign maneuver but very significant for a patient as it provides dramatic relief of symptoms.
This week The New England Journal of Medicine has a nice writeup on Superior Vena Cava Syndrome with Malignant Causes - Volume 356:1862-1869, Number 18, May 3, 2007
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