by Mark | Sep 8, 2015 | Cardiac Electrophysiology, Cardiology, General Public
What is atrial tachycardia? Atrial tachycardia (AT) is a disorder of fast heart rhythm that begins in the upper chambers of the heart, the left and right atria (1). AT can start from one area, or focus, in either atrium and is called focal AT. AT can also arise from multiple different areas of the atria, and is called multifocal AT. Regardless the mechanism (focal vs. multifocal), the extra early signals that start from the focus/foci spreads centrifugally out to affect the atria and ventricles, and thus speeds up heart rate. The racing heart may be felt by the patient as palpitations, dizziness, chest pain or lightheadedness, or in some people may be asymptomatic (2). Occasionally, fast AT seen in younger patients can cause them to pass out. AT has two unique characteristics that distinguish it from other similar atrial rhythm disorders: 1) they often occur in repetitive short bursts, and 2) AT episodes exhibit “warm up” and “cool down” periods where rate varies at initiation and termination of the arrhythmia (1). Although short bursts of AT are common, sustained AT is a more rare cause of sustained arrhythmias from the atria (supraventricular tachycardia, SVT). Of all episodes of SVT encountered by electrophysiologists, AT is the cause only about 5-15% of the time (2-3). The diagnosis of AT is usually straightforward and starts with a thorough medical history and physical examination. If the patient is exhibiting AT during the exam, then an electrocardiogram (ECG) may demonstrate a fast heart rhythm consistent with AT. Cardiologists would recognize AT on the ECG as 1:1 P-QRS coupling, with non-sinus P-wave morphology, and usually long R-P...
by Mark | Sep 2, 2015 | Cardiology
The Most Important Articles in Hypertension Below are what I believe to be the most important articles in hypertension in mid-2015. Each blue trial name is a link to the trial page. In many cases where the journal article is open access, the link will open the full article. Otherwise, a Pubmed or Abstract page will open. Enjoy! ALLHAT JNC7 Guidelines JNC8 Guidelines ACCOMPLISH (benazepril plus: either amlodipine or HCTZ) HYVET (indapamide diuretic) MRFIT UKPDS Compendium ABCD MDRD HOT AASK ASCOT Studies ACCORD Disclaimer © 2015 www.markmccauleymd.com. All rights served. ...
by Mark | Aug 29, 2015 | Cardiac Electrophysiology, Cardiology, General Public
What is Atrial Fibrillation? Atrial fibrillation is the most common sustained arrhythmia in the human heart (1). In the United States today, over 5.6 million patients have been diagnosed with atrial fibrillation and this number is growing; by the year 2030 it is estimated that this diagnosis will extend to 12.1 million Americans (2). Atrial fibrillation is a disease of rapid, chaotic electrical activity in the upper chambers of the heart, the left and right atria (3). Normally, each heartbeat starts in the normal, natural pacemaker of the heart, the sinoatrial (SA) node which lies in the right atrium. A normal heartbeat depends on an electrical wave that begins in the SA node and travels out from this node to first cover both atria, then traverses the AV node, which is a bridge to the ventricles, and finally to the ventricles, the main pumping chambers of the heart. When atrial fibrillation starts, rapid irregular electrical signals occur in the atria apart from the SA node and “take over” the heart rhythm from the top down. In other words, these rapid chaotic electrical impulses suppress the normal “sinus” rhythm of the heart, and create a chaotic irregular heart rhythm. One analogy for atrial fibrillation is a fireworks show. If you were listening to your favorite song, and really wanted to focus listening to the song’s rhythm, it would be simple if you were sitting in your room quietly with your headphones on. However, try listening to the rhythm outdoors at a fireworks show, for example on the 4th of July, and it would be an entirely different experience. The rapid chaotic...
by Mark | Aug 29, 2015 | Cardiology
The Most Important Articles in Peripheral Arterial Disease Below are what I believe to be the most important articles in peripheral arterial disease in mid-2015. Each blue trial name is a link to the trial page. In many cases where the journal article is open access, the link will open the full article. Otherwise, a Pubmed or Abstract page will open. Enjoy! CAPRIE (clopidogrel vs. aspirin) CHARISMA (clopidogrel + aspirin) WAVE (OAC vs. anti-plt) HOPE (ramipril) VADT (glucose control, strict vs conservative) ADVANCE (glucose control) EDIC (glucose control, DM type I) HPS (simvastatin) CARP (coronary revascularization timing vs. vascular surgery) EVAR (AAA repair, EVAR) DREAM (EVAR vs. surgical AAA repair) Guidelines Peripheral Arterial Disease Guidelines Disclaimer © 2015 www.markmccauleymd.com. All rights served. ...
by Mark | Aug 26, 2015 | Cardiology
The Most Important Articles in Heart Failure Below are what I believe to be the most important articles in heart failure in mid-2015. Most of the ICD trials are actually covered in the EP trials section. Each trial is divided into categories, and each blue trial name is a link to the trial page. In many cases where the journal article is open access, the link will open the full article. Otherwise, a Pubmed or Abstract page will open. Enjoy! Beta Blockers CAPRICORN (carvedilol) CIBIS-I, CIBIS-II (bisoprolol) MERIT-HF (metoprolol XL) US-CARVEDILOL BEST (bucindolol) COPERNICUS (carvedilol) COMET (carvedilol vs. metoprolol) MOCHA (carvedilol) SENIORS (nevibolol) OPTIMIZE-HF (beta blockers) ACE Inhibitors HOPE (ramipril) SOLVD (enalapril) SAVE (captopril) ATLAS (lisinopril dosing) CONSENSUS (enalapril) OPTIMAAL (losartan vs. captopril) VALIANT (valsartan, captopril) Angiotensin Receptor Blockers CHARM, CHARM-ALTERNATIVE, CHARM-PEF (candesartan) I-PRESERVE (irbesartan, HFpEF) PEP-CHF (perindopril) TOPCAT (spironolactone, HFpEF) Aldo-DHF (spironolactone, HFpEF) VALHEFT, A-HEFT ELITE-I, ELITE-II (losartan) Other Therapies SCD-HeFT (amiodarone vs. ICD) ALLHAT (thiazide diuretics & HTN) DIG (digoxin) RALES (spironolactone) EPHESUS (eplerenone) EMPHASIS-HF (eplerenone) TREAT (darbapoietin-alpha) RED-HF (darbapoietin-alpha) DOSE (furosemide, bolus vs. continuous) ASCEND-HF (nesiritide) REMATCH (LVAD) RELAX WARCEF Guidelines Heart Failure Guidelines Disclaimer © 2015 www.markmccauleymd.com. All rights served. ...
by Mark | Aug 18, 2015 | Cardiology
The Most Important Articles in Ischemic Heart Disease, Coronary Artery Disease, and Myocardial Infarction (MI) Below are what I believe to be the most important articles in coronary heart disease in mid-2015. Each trial is divided into categories, and each blue trial name is a link to the trial page. In many cases where the journal article is open access, the link will open the full article. Otherwise, a Pubmed or Abstract page will open. Enjoy! Coronary Artery Bypass Grafting (CABG) VA-CABG CASS STICH CARP PCI COURAGE CARDia TACTICS/TIMI-18 TIMACS OAT APEX-AMI SIRIUS (sirolimus DES) TAXUS-IV (paclitaxel DES) REACT STREAM (rescue PCI) TRANSFER-AMI (rescue PCI) CARESS-IN-AMI BCIS-1 DEFER (FFR) FAME (FFR) CABG vs. PCI BARI SYNTAX FREEDOM SHOCK SHOCK-II Medical/Adjunctive Therapy for Ischemia/Infarct HOPE (ramipril) BARI-2D OASIS-V (enoxaparin vs. fondaparinux) SYNERGY (enoxaparin vs. unfractionated heparin) TIMI-11b (enoxaparin vs. unfractionated heparin in UA/NSTEMI) Antiplatelet Trialists’ Intervention: High Risk Low Risk CURRENT/OASIS-7 (aspirin & clopidogrel factorial) CURE (clopidogrel) TRITON/TIMI-38 (prasugrel vs. clopidogrel) TRILOGY-ACS (prasugrel vs. clopidogrel) PLATO (ticagrelor vs. clopidogrel) COGENT (clopidogrel/PPI) GRAVITAS (clopidogrel dosing) ACUITY (heparin+GPIIb/IIIa vs. bivalirudin+GPIIb/IIIa vs. bivalirudin) HORIZONS-AMI (bivalirudin) CAPTURE (abciximab) EARLY-ACS (eptifibatide) COMMIT (beta blocker, acute MI) POISE (toprol XL) DECREASE (bisoprolol, perioperative) TRIUMPH (tilarginine, shock) WOEST (clopidogrel without aspirin) CREDO (clopidogrel) GUSTO-1 GUSTO-3 (t-PA, streptokinase) GISSI-1 GISSI-2 (streptokinase, alteplase) ISIS-2 (streptokinase) INTIME-2 (lanoteplase) ASSENT-2 (tenecteplase vs. alteplase) Cholesterol-Lowering Drugs and Outcome ARIC / ARIC (rosuvastatin) JUPITER (rosuvastatin) PROVE-IT/TIMI-22 (pravastatin/atorvastatin) A-TO-Z (simvastatin) Acute Pericarditis ICAP (colchicine) COPE (colchicine) Scoring Systems in AMI GRACE Scoring System TIMI Risk Score UA/NSTEMI Guidelines Unstable Angina / NSTEMI STEMI PCI CABG Surgery Cholesterol Disclaimer © 2015 www.markmccauleymd.com. All rights...
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