November 23, 2020

Background: Approximately one in four adults over forty-five years of age will develop atrial fibrillation (AF) during their lifetime. There is a clear association between AF and premature death, ischemic stroke, and cardiovascular events in the first year after atrial fibrillation is diagnosed (“Early atrial fibrillation”). Treatment for AF broadly consists of two categories: rate-control to slow ventricular response rate, and rhythm-control in an attempt to maintain a sinus rhythm. However, there is no systematic evidence that rhythm control treatment improves outcome in atrial fibrillation patients. Observations support that the presence of fibrillation is one of few modifiable factors associated with death in AF patients. Current guidelines for treating AF are largely based on individual factors that are often influenced by impressions of the treating physician. Furthermore, therapy for AF is only indicated in patients with recurrent AF. In summary, the treating physician is left alone in the important therapeutic decision as to whether pursuing sinus rhythm is important in a given patient.

October 19, 2020

Background: Spontaneous coronary artery dissection (SCAD), once thought of as a rare “zebra” diagnosis that was universally fatal, is now being increasingly recognized as a cause of acute coronary syndrome (ACS), particularly in women due to increased vigilance, greater utilization of coronary angiography and advanced imaging. Despite these advances, SCAD still remains one of the most enigmatic syndromes in cardiology. It carries a high misdiagnosis and mistreatment rate with lack of consensus on investigation or treatment. Here we review the salient features of SCAD to increase awareness of this disease entity and further our understanding of this unique disease process.

October 10, 2020

From Oct 6th – 8th, 2020, Haney Mallemat (@CriticalCareNow) and his team put on an absolutely amazing online critical care conference called ResusX Rewired.  ResusX is a conference designed by resuscitationists to provide clinicians with the most up to date skills and knowledge to help make a difference in your patients' lives.  Haney and his crew made a combination of short-format, high-yield lectures, and completely customizable small group sessions with procedural demos seem easy.  There were so many high-quality speakers and pearls that I learned from this conference that I wanted to archive them here in one post for reference and to share with our readers/followers.

October 8, 2020

Background: Prior to the discovery of thrombolytics, clinicians could only observe their patients completing their myocardial infarctions and then classify them according to whether their subsequent ECGs developed Q waves. When trials showed a clear survival benefit with thrombolytics (especially in STE) this shifted the paradigm from “Q-wave/ non Q-wave MI” to “STEMI / non-STEMI”. Eventually STEMI became synonymous with acute coronary occlusion (ACO) requiring reperfusion, except this connection was never studied in trials. Unfortunately, the STEMI criteria have limited diagnostic criteria for ACO, leading to false cath lab activation. And worse, missing ⅓ of ACO (NSTEMI), depriving them of emergent reperfusion therapy. This led many authors to shift from STEMI/ NSTEMI to ACO-MI/ non- ACO-MI. 

September 30, 2020

Take Home Points
  • 100k people in US have sickle cell, the majority will at some point develop acute chest syndrome (ACS)
  • The mortality rate per episode is 3-9%, similar to those of STEMI
  • ACS is a syndrome - CXR infiltrate + respiratory symptoms
  • Treat it aggressively and early (antibiotics, respiratory support)
  • If you’re considering exchange transfusion - get hematology onboard quickly