Wednesday, April 25, 2018

What is a master clinician-teacher?

Tuesday, April 24, 2018

A case illustrating the differential diagnosis of long RP tachycardia

Read here.

Monday, April 23, 2018

Idiopathic paroxysmal AV block due to low baseline adenosine levels and heightened receptor sensitivity

Idiopathic paroxysmal AV block poses a true diagnostic challenge. Although it is true that the clinical presentation does not differ from that of another cardiogenic syncope, the diagnosis of this block requires the lack of a structural cardiac pathology that justifies the observed manifestations and an absence of electrocardiographic disorders prior to an episode. For diagnosis, it is useful the implantable loop recorder to substantiate AV block paroxysms and assess their clinical correlations.

The mechanism associated with idiopathic paroxysmal AV block is unknown. It has been postulated that patients with low basal adenosine levels exhibit hyperaffinity of the adenosine receptors of the AV node. No relevant data have been reported, so it´s necessary that more studies are needed to confirm this hypothesis.

The prognosis of idiopathic paroxysmal AV block is favorable, given the paroxysmal profile of the AV block and the low probability of degeneration into permanent forms of AV block. Permanent stimulation devices can be employed to prevent and avoid the recurrence of syncopal episodes in patients with idiopathic paroxysmal AV block.

Saturday, April 21, 2018

Atypical presentation of retroperitoneal hematoma 3 weeks after IVC filter insertion

Report here.

Friday, April 20, 2018

Pitfalls in ICU management

This article in Today's Hospitalist, drawn from recent talks at the UCSF hospitalist conference, has a lot of pearls. Most of the admonitions are about avoiding knee jerk care.

The real gem comes in her discussion of the importance of de-escalation of IV fluids:

“Multiple studies have replicated that, even in sepsis,” Dr. Santhosh noted. “After initial resuscitation with early goal-directed therapy, you want a maintenance or stabilization phase and then de-escalation.” That could mean active diuresis in patients to attain a negative fluid balance once they’re off pressors.

And while it can be a challenge to find the maintenance fluids in your EHR to discontinue them…

That’s right. She said, in effect, that the EHR interferes with the clinician’s ability to discontinue potentially harmful IV fluids. The statement rings true and concerns one of those key provisions of meaningful use: CPOE. Meaningful to patients for sure if it interferes with their care with the potential for harm.

Thursday, April 19, 2018

Hypothyroidism and heart disease

Free full text review.

From the review:

Hypothyroidism can result in decreased cardiac output, increased systemic vascular resistance, decreased arterial compliance, and atherosclerosis.

Impaired cardiac muscle relaxation, decreased heart rate, and decreased stroke volume contribute to heart failure in hypothyroidism.

Subclinical hypothyroidism is associated with ischemic heart disease and increased cardiovascular mortality.

Treatment of hypothyroidism may have a beneficial impact on several parameters of cardiac dysfunction, including subclinical hypothyroidism, especially in younger individuals.

Wednesday, April 18, 2018

Cardiac manifestations of hyperthyroidism

Free full text review.