Author Archive for: srrezaie

SCOT-HEART: CCTA Decreases Long-Term Risk of MI and Death?

22 Oct
October 22, 2018

Background: CT coronary angiography (CTCA) is a relatively new technology that has gained popularity over the past few years in evaluating patients presenting with chest pain. CTCA is an anatomic test that has been shown to increase downstream testing and increase healthcare costs but its impact on patient-oriented benefit has been questioned. Early concerns of CTCA including poor image quality in the obese and high levels of radiation exposure have been mitigated by improved technology.

Another trial, called PROMISE, also evaluated anatomic CCTA vs functional stress testing in greater than 10,000 patients with symptomatic chest pain with suspected CAD.  In this study an initial strategy of CCTA was not associated with better clinical outcomes compared to functional testing over a median follow-up period of two years, and it was also associated with higher radiation exposure and downstream testing.

In this post we will cover the original SCOT-HEART trial published in 2015 [1] and the 5 year follow up of the original SCOT-HEART trial [2]. Read more →

Clinical Pearls from ACEP 2018 – San Diego, CA

18 Oct
October 18, 2018

This year ACEP 2018 took place in San Diego, CA from Oct 1st– 4th, 2018.  There were lots of amazing speakers and topics as was evidenced by the eruption of everyone’s twitter feeds with the #ACEP18 hashtag.  I was fortunate enough to not only attend, but also speak at this amazing conference.  I was approached by several attendees requesting that I put together a list of my favorite pearls from this conference, as I have done in years past on REBEL EM.  Below is my top 10 list, in no particular order. Read more →

Coronary Computed Tomography Angiography (CCTA): The Holy Grail of “Low Risk” Chest Pain Evaluation?

11 Oct
October 11, 2018

Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of high-risk disease compared to standard physiologic testing.  However, many published trials on CCTA were not adequately powered to evaluate patient oriented end points.  The aim of the current published study was to perform a systematic review and meta-analysis comparing CCTA with other standard of care (SOC) approaches in evaluation of patients with acute chest pain. Read more →

LOMAGHI Trial: Magnesium Sulfate for Rapid Atrial Fibrillation?

04 Oct
October 4, 2018

Background: Currently, several medications are recommended for the management of atrial fibrillation with rapid ventricular response in the emergency department including calcium channel blockers, beta blockers and digoxin (the optimal choice is still up for debate). Magnesium sulfate may play a role as a supplemental medication based on its ability to decrease the frequency of sinus node depolarization, prolongation of the refractory period of the atrioventricular node, and acting as a calcium antagonist inhibiting calcium currents in cardiomyocytes.  In addition,panerai radiomir replica intravenous magnesium is safe and cheap.  Most previous trials on the use of magnesium sulfate have rather small sample sizes or were performed in post-cardiac surgery patients.  Also, the exact dose of magnesium used in previous studies varied significantly making it difficult to determine which dose would be the most optimal in these patients.  Recently, the LOMAGHI study was just published trying to answer the questions behind many of these issues. Read more →

Building the “Perfect” Curriculum

02 Oct
October 2, 2018

I was asked to give a talk at ACEP 2018 on Building the Perfect Curriculum and given 25 minutes to make this happen.  As you can imagine there is no way the entirety of building a perfect curriculum can be done in 25 minutes nor is there such a thing as the perfect curriculum, as we are always evaluating and modifying our current curriculum. Therefore the perfect curriculum can always get better.  For the sake of this talk however, there are essentially 3 steps to building the perfect curriculum: A needs assessment, optimizing the learning, and evaluation of the curriculum.  I opted to focus on optimizing learning.  Every year it seems this talk focuses on Kerns 6 step approach to curriculum development, (which is simply one of many models out there) but there is no emphasis on what to do during lectures and weekly conferences. Read more →