Heart failure patients can safely spend time at altitude

Excellent IPD analysis presented at the AHA regarding Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction - New England Journal of Medicine - needing a little bit of nuance for doctors treating MI patients. “My concern is that the current narrative risks portraying beta-blocker withdrawal as broadly safe, while in fact this is true only for a small subset of carefully selected, low-risk patients. Many others—those with larger infarcts, mild LV dysfunction <50%, incomplete revascularization, or concomitant hypertension—continue to derive clear benefit. In these subgroups, discontinuation could be harmful.” https://lnkd.in/epkQp44k

Theophylline-induced atrial fibrillation with a relevant case example and supporting literature: Atrial fibrillation (AF) induced by theophylline is a rare but important adverse effect to recognize in emergency medicine practice. I recently encountered a notable case of a 60-year-old female who had presented with shortness of breath elsewhere and was administered theophylline for respiratory symptoms. Shortly after, she developed atrial fibrillation with a rapid ventricular rate with HR of 180 to 220. promptly reffered to us for further management.This clinical scenario aligns with documented evidence that theophylline can precipitate AF due to its cardiac electrophysiological effects. Theophylline, a phosphodiesterase inhibitor used primarily for chronic obstructive pulmonary disease (COPD) and asthma, can enhance atrioventricular conduction and trigger atrial arrhythmias. A case of a 60-year-old woman with COPD and hypertension who developed AF with a heart rate of 180–220 bpm soon after starting theophylline 400 mg. Restoration to sinus rhythm was achieved with iv Amiodarone therapy alongside anticoagulation, emphasizing the importance of timely recognition and intervention . Supporting this, a study involving atrial fibrillation patients treated with theophylline showed the drug increased ventricular response rate by over 12%, complicating rate control especially in acutely ill patients . Another report highlighted cases of intravenous aminophylline (a theophylline derivative) inducing AF even at therapeutic serum levels . Emergency physicians should carefully monitor cardiac rhythm when initiating theophylline, especially in older patients or those with comorbidities. Early detection and management can prevent complications such as hemodynamic instability. References: Case report of theophylline-induced AF with rapid ventricular response (66-year-old female) Increased ventricular rate with theophylline in AF patients (study of 8 patients) Aminophylline-induced AF with therapeutic serum levels #EmergencyMedicine #AtrialFibrillation #Theophylline #Cardiology #ClinicalCase #RapidResponse #simshospitals #DrSyedHarris

📢📢The prone position is a helpful therapy for patients with atelectasis and ARDS because it improves ventilation and oxygen saturation. This is achieved by better matching ventilation and perfusion in the lungs, recruiting collapsed alveoli, and creating a more uniform distribution of stress and strain throughout the lungs. 📌How prone positioning works ✔️Improves ventilation-perfusion (V/Q) matching: In the supine position, gravity causes blood flow to be concentrated in the lower parts of the lungs, while ventilation is more uniform. Turning a patient prone shifts ventilation to better-perfused dorsal lung regions, creating a better match and improving gas exchange. ✔️Recruits collapsed lung areas: The prone position helps to open up collapsed alveoli, particularly in the posterior and dependent lung regions, which are more prone to collapse in the supine position. ✔️Reduces lung stress: By distributing pressure more evenly across the lungs, the prone position helps to prevent overdistension in some areas and the collapse and reopening of alveoli in others (atelectrauma). ✔️Improves secretion clearance: The position can aid in clearing secretions from the lungs. Benefits for patients with ARDS and atelectasis ✔️Improved oxygenation: Studies show a significant increase in the ratio after being placed in the prone position. ✔️Reduced mortality: For patients with severe ARDS, prone positioning has been shown to decrease mortality rates. ✔️Reduced need for intubation: In some non-intubated patients with COVID-19 ARDS, the prone position has helped improve oxygenation and reduce the need for intubation and mechanical ventilation. 📌Important considerations The maneuver requires a skilled team and should be performed carefully to avoid complications like pressure sores, dislodged tubes, and facial edema. It is contraindicated in patients with unstable spinal fractures. The optimal duration of prone positioning is often 16 hours per day, based on studies such as the PROSEVA trial. The image is taken from Figure 1 of the article below CMAJ November 23, 2020 192 (47) E1532-E1537; DOI: https://lnkd.in/deabNCze

Big News!! Mayo Clinic Study Confirms Biobeat’s Accuracy and Reliability! A new study published in the Journal of Human Hypertension by researchers at Mayo Clinic validated Biobeat’s cuffless blood pressure monitoring against the gold standard of invasive arterial line measurements in ICU patients. ✅ Key outcomes: • Strong correlation with intra-arterial pressure for SBP, DBP, and HR. • Minimal bias and excellent agreement (95% of SBP and 99.9% of DBP within 10 mmHg of reference). • Accuracy consistent across all skin tones and patient positions. These results confirm Biobeat’s leadership in clinical accuracy and reliability, setting a new benchmark for non-invasive, continuous, cuffless blood pressure monitoring that enhances patient care and reduces the limitations of traditional ABPM. The evidence is here!!. At Bionex in partnership with Biobeat , we’re committed to unlocking the full potential of this innovation for the greatest number of patients in LATAM. With a powerful tool for hypertension diagnosis, monitoring and prevention at our disposal, we can: • Detect elevated blood pressure earlier and more accurately, • Monitor patients continuously, not just in the clinic, • Intervene proactively to reduce the risk of cardiovascular events. The challenge is no longer “Can we?” it’s “How many will we reach, and how soon?” Our focus now must be on deploying, scaling, and delivering meaningful benefit in real-world care settings. Let’s lean in. Let’s make sure technology doesn’t just sit on the shelf… it changes lives. I invite you to read the full study https://lnkd.in/dyJ5-rev

Blood Thinners May No Longer Be Needed for Many with Irregular Heartbeats A new study has revealed that many patients with atrial fibrillation (AFib), a common condition causing irregular heartbeats, may no longer require daily blood thinners to prevent strokes. Traditionally, medications such as warfarin or newer direct oral anticoagulants (DOACs) were prescribed to prevent clot formation, which can lead to heart attacks or strokes. Researchers found that with advanced heart monitoring and improved rhythm control, patients with mild or well-managed AFib may safely reduce or even discontinue long-term use of blood thinners under medical supervision. This represents a major shift toward personalized treatment, where therapy is based on an individual’s heart rhythm patterns rather than a one-size-fits-all approach. This change could lower the risks associated with blood thinners, such as internal bleeding, while simplifying patient care and reducing medication costs. However, experts emphasize that not all patients can stop these drugs; those with high-risk conditions like hypertension, diabetes, or prior stroke still need preventive treatment. The study highlights how digital health monitoring and precision medicine are transforming cardiology, offering safer and more adaptive care options for millions living with AFib worldwide. For full details and to collect engagement points, follow @Miraba.Health or Toronto Health Hub on Instagram & X.

Published (Project #24CS001) Contemporary Practice Patterns of Vasoactive Use in Cardiogenic Shock in the American Heart Association Cardiogenic Shock Registry https://lnkd.in/g4zqFD5F Siddharth M. Patel, MD, MPH; David D. Berg, MD, MPH; Erin A. Bohula, MD, DPhil; Michael G. Palazzolo, MS; Wayne B. Batchelor, MD; Stavros G. Drakos, MD, PhD; Arman Kilic, MD; Robert L. Kormos, MD; Marc D. Samsky, MD; Mariell Jessup, MD; Mitchell W. Krucoff, MD; David A. Morrow, MD, MPH JAHA  Dr. Patel “This first report from the AHA Cardiogenic Shock Registry offers a unique lens into the management of cardiogenic shock across the United States, underscoring the need for further research to understand the risks and benefits of widely used treatments.”  This study used a new national registry created by the American Heart Association that tracks key data among patients admitted with cardiogenic shock, a serious condition that occurs when the heart is no longer able to pump enough blood to adequately supply other organs in the body, to help understand how clinicians across hospitals in the United States select specific medications for initial stabilization of this condition. Medications that both help the heart pump stronger and squeeze the blood vessels – called “inopressors” – were the most common type of medication used, with norepinephrine being used at least twice as commonly as other alternatives. However, there were differences in medication selection based on the severity and the cause of cardiogenic shock – particularly for patients who developed this condition in the setting of a heart attack compared to others with a longer standing problem with the pumping function of the heart. Given that no studies have rigorously demonstrated clear benefits with the use of one agent over another, these findings highlight the importance of further investigation to examine the risks and benefits of these ubiquitously used agents in the different types of cardiogenic shock in order to better guide clinicians in selecting the optimal medications for treatment. 

𝗛𝘆𝗽𝗲𝗿𝘁𝗲𝗻𝘀𝗶𝗼𝗻 – 𝗮 𝗰𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲 𝘁𝗵𝗮𝘁 𝘀𝘁𝗶𝗹𝗹 𝗿𝗲𝗾𝘂𝗶𝗿𝗲𝘀 𝗼𝘂𝗿 𝗮𝘁𝘁𝗲𝗻𝘁𝗶𝗼𝗻ⵑ Hypertension is a chronic condition affecting approximately one-third of the adult population worldwide. 𝗜𝗻 𝗣𝗼𝗹𝗮𝗻𝗱, 𝘁𝗵𝗶𝘀 𝘁𝗿𝗮𝗻𝘀𝗹𝗮𝘁𝗲𝘀 𝘁𝗼 𝗼𝘃𝗲𝗿 𝟭𝟭 𝗺𝗶𝗹𝗹𝗶𝗼𝗻 𝗽𝗲𝗼𝗽𝗹𝗲. Despite the availability of pharmacological treatments, at least half of patients do not reach their therapeutic targets. Hypertension remains one of the most dangerous yet often underestimated cardiovascular risk factors. Uncontrolled blood pressure increases the risk of stroke, heart attack, heart failure, and kidney disease. Studies show that about 5% of hypertensive patients suffer from resistant hypertension, despite appropriate medication use. In this group, modern interventional techniques can play a key role, not only for patients with resistant hypertension but also for those who, for various reasons, cannot take certain medications long-term. As an interventional cardiologist, my goal is to combine the effectiveness of pharmacological therapy with innovative interventional solutions. The aim is to ensure that every patient has the opportunity for better quality of life and a real reduction in cardiovascular risk. I am honored to collaborate with experts in hypertension management and in the practical implementation of guidelines from the European Society of Hypertension and the European Society of Cardiology. Our shared goal is to develop tools that are effective, safe, and cost-efficient, in the broadest sense of the term. Hypertension remains a serious challenge, but through collaboration, advanced knowledge, and innovative techniques, we can make a tangible difference in patients’ lives. This is one of my priorities for the near future. ______________________ #HypertensionAwareness #CardiovascularHealth #HeartHealth #BloodPressureMatters #ResistantHypertension #InterventionalCardiology #ESCguidelines #PatientCare #InnovativeCardiology

I recently came across an interesting case report in JACC Case Reports : An 83-year-old woman presented with what appeared to be a heart attack but turned out to be Takotsubo cardiomyopathy (stress-induced cardiomyopathy) complicated by an acute ventricular septal defect—a life-threatening condition with typically poor outcomes. The winning strategy: Early diagnosis through comprehensive imaging and hemodynamic assessment , Impella CP device placed within 2 hours, Urgent surgical repair within 32 hours , BiPella (biventricular Impella) support post-operatively , Multidisciplinary team approach The outcome: At 17-month follow-up, the patient showed remarkable recovery with improved left ventricular function and complete resolution of the VSD. Key takeaways for cardiovascular professionals: Early recognition saves lives Mechanical circulatory support can bridge critical patients to definitive treatment Individualized treatment strategies matter, especially in elderly patients with multiple comorbidities Innovation in cardiac support devices continues to expand our treatment options This case reminds us that even in complex, high-risk scenarios, timely intervention combined with advanced technology can lead to outstanding outcomes. Read the full case report: https://lnkd.in/eKkyiBXa

Acute pulmonary embolism (PE) remains a major global cause of cardiovascular morbidity and mortality, demanding rapid recognition, risk stratification, and tailored management. This review synthesizes current evidence surrounding the acute and long-term care of patients with PE, emphasizing initial stabilization, anticoagulation strategies, reperfusion therapies, and indications for invasive intervention. Special focus is placed on differentiating PE from clinically overlapping cardiopulmonary conditions, identifying prognostic markers, and mitigating both immediate and long-term complications, including chronic thromboembolic pulmonary hypertension (CTEPH). Post-embolism rehabilitation, frequently underutilized, is highlighted as a key component in improving functional recovery and quality of life. The review concludes by underscoring the critical role of multidisciplinary collaboration, particularly through Pulmonary Embolism Response Teams (PERTs), in optimizing patient outcomes and ensuring cohesive, evidence-based care across the healthcare continuum.

✅ New study highlights the importance of #cardiovascular #magnetic_resonance (#CMR) in diagnosing cardiac involvement in #systemic_lupus_erythematosus (#SLE). Researchers found that cardiac ischemia is a common cause of chest symptoms in SLE patients, and CMR helped detect and treat these conditions in 32% of cases. This study emphasizes the value of CMR in early detection and management of cardiac issues in SLE patients. ♾️♾️♾️♾️♾️ https://lnkd.in/eKCfHkyD