cnewtoncheh.bsky.social
heart failure & transplant cardiologist | cardiovascular geneticist | Mass General Hospital | all posts my opinion | strong supporter of a free press | #CardioSky
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This was just reported at press release an hour ago at Mass General Hosp. www.massgeneral.org/news/press-r...
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The level of corruption in the US government is outrageous. These letters lay out the boundaries of the corruption. If officials adhere to them.
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I think you articulate the reasons to consider very short-acting dobutamine if MAP not too low or epinephrine if MAP is too low over milrinone (too long-acting so not good for uptitration, OK for downtitration.
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Americans would love to pay an extra tax to the US government on their Ozempic, currently too cheap. Right.
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Nonconducted PACs
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I’m a bad person. Watched full series with my then 6yo. He’s now 20 and seems OK now at least on the outside.
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www.rcfp.org Reporters Committee for Freedom of the Press
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freedom.press Freedom of the Press Foundation
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Consider these organizations if you have capacity to make a charitable contribution to these non-profits.
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I’ve had young lean female patients with chronic low BP syncopize after mRnA vax #2. Any cause of inflammation can tip the balance.
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It’s pretty much the same tactic as going on strike during Christmas shopping season (I support collective bargaining). It definitely increases the leverage because it inflicts maximal pain.
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I think peer review of papers (if mentor actually engages substantially) helps also. Forces reading papers with both the perspective of a reader and a writer. Significantly improves the quality of writing.
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I think the popularity of specialties often comes down to “what cans you do to ameliorate”. Onc and cardiology benefit from excitement over new effective treatments. I would imagine as renal therapeutics continue to make inroads, interest will improve. Renal xenotransplant trials will help.
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The coursening of discourse in our country is demoralizing
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Good. We’re going to need people who know how to treat these currently rare diseases if RFK’s plan is followed.
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I was not assuming a positive review. Looks like goose or duck export on a sod backdrop.
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How does one stop it? Constant blocking. Can’t keep up.
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Yes, confounding.
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Why amiloride over valsartan to attenuate the HCTZ kaliuresis and augment BP lowering?
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Potassium Citrate is absorbed and the citrate is metabolised to bicarbonate. Bicarbonate leads to an increase in the pH value and thus leads to a transfer of potassium from the blood into the cells and thus increases hypokalemia.
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I think the indication matters. Agree that it should have a tiny role in HTN Tx.
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I don’t say no one should prescribe doxorubicin just because it can cause HFrEF.
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OK. HTN guidelines do not recommend hydralazine as 1st or 2nd line and adherence is challenging. But HFrEF guidelines do for persistent HFrEF despite ARNI/BB/MRA.
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That could be bad for patients with heart failure with reduced ejection fraction
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Not sure I follow your point. We use independent risk markers all the time to decide to eg give statins for high risk of ASCVD even if the older age component is not modifiable. Or anticoagulant for pts w high CHADS-Vasc w AF even if the diabetes component is not modifiable.
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LDL not IDL
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The independence of elevated Lp(a) from elevated lDL as a risk factor for ASCVD is not in question. What is not yet established is whether it is a modifiable ASCVD risk factor. Ongoing trials of Lp(a)-lowering Tx will establish /disprove this hypothesis.
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Now you’re talking!
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Important also to remember that genetic variation determines plasma Lp(a) level (more than LDL) and thus high Lp(a) should prompt first-degree relative screening same as very high LDL levels.
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I agree. I try to document nadir EF and current EF and its trajectory (improving/falling) as well as whether GDMT tolerance is increasing or decreasing. I find the lack of nuance in the HFrEF, HFrecEF, HFimpEF terms to be barriers to understanding the indicated therapies.
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I use the phrase suggested above HFrEF with improved (not recovered) EF, mostly so PCPs or others (esp if care transferred to new institution) don’t stop HFrEF meds. Can’t see a compelling reason to use HFrecEF or cardiomyopathy (could be HCM, ATTR-CM).