STRESS-L RCT – Beta-Blockers in Septic Shock?
Spoon Feed
A randomized trial of patients in septic shock on norepinephrine found no benefit in those treated with an infusion of landiolol (β1-blocker). The trial was stopped early for concern of potential harm in the intervention group.
Source
Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial. JAMA. 2023 Nov 7;330(17):1641-1652. doi: 10.1001/jama.2023.20134.
Asymptomatic Brugada – A Silent Danger
Spoon Feed
Risk stratification of patients with asymptomatic Brugada remains a clinical dilemma and makes expectant guidance difficult. This article has demonstrated the highest risk of arrythmia in those with spontaneous type-1 BrECG (Brugada ECG) as compared to those with drug-induced-only BrECG.
Source
Asymptomatic Patients With Brugada ECG Pattern: Long-Term Prognosis From a Large Prospective Study. Circulation. 2023 Nov 14;148(20):1543-1555. doi: 10.1161/CIRCULATIONAHA.123.064689. Epub 2023 Oct 13.
How to Lower Your Mortality (And Your Patients) – One Step at a Time
Spoon Feed
There is a nonlinear inverse dose-response trend between daily step count and all-cause death and cardiovascular disease, with progressive risk reductions starting at as few as 2500 to 2700 steps/day, independent of sex. Walking faster provided additive health benefits.
Source
Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events. J Am Coll Cardiol. 2023 Oct 10;82(15):1483-1494. doi: 10.1016/j.jacc.2023.07.029. Epub 2023 Sep 6.
Can We Simplify a HEART Score to a HET Score?
Spoon Feed
Both the HEART- and HET-score (using history, ECG changes, and high-sensitivity troponin) performed similarly when risk-stratifying ACS rule-out patients, but the HET-score had higher overall diagnostic accuracy.
Source
HEART-score can be simplified without loss of discriminatory power in patients with chest pain - Introducing the HET-score. Am J Emerg Med. 2023 Oct 1;74:104-111. doi: 10.1016/j.ajem.2023.09.037. Epub ahead of print.
Loperamide (Imodium) and Mitragynine (Kratom) and Risk of Ventricular Arrhythmia
Spoon Feed
Loperamide, an over-the-counter antidiarrheal opiate, and mitragynine (kratom) are both associated with ventricular arrhythmia and death.
Source
Ventricular Arrhythmias Associated With Over-the-Counter and Recreational Opioids. J Am Coll Cardiol. 2023 Jun 13;81(23):2258-2268. doi: 10.1016/j.jacc.2023.04.009.
STREAM-2 RCT | Half-Dose Tenecteplase for STEMI
Spoon Feed
The STREAM-2 trial found half-dose tenecteplase was effective in treating STEMI patients ≥60, though with increased risk of intracranial hemorrhage.
Source
STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Circulation. 2023 Aug 29;148(9):753-764. doi: 10.1161/CIRCULATIONAHA.123.064521. Epub 2023 Jul 13.
AHA Guideline | 10 Tips Life-Threatening Toxicity From Poisoning
Spoon Feed
Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.
New DOAC Score Outperforms HAS-BLED for Major Bleeding
Spoon Feed
The new DOAC score had stronger predictive performance for major bleeding in patients on anticoagulation for atrial fibrillation (A-fib) compared to the HAS BLED score.
Source
Development and Validation of the DOAC Score: A Novel Bleeding Risk Prediction Tool for Patients With Atrial Fibrillation on Direct-Acting Oral Anticoagulants. Circulation. 2023 Sep 19;148(12):936-946. doi: 10.1161/CIRCULATIONAHA.123.064556. Epub 2023 Aug 25.
How to Spot Ischemia in RBBB Patients
Spoon Feed
In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. ST segment elevation, or even an isoelectric ST segment, in these leads is abnormal and should make us concerned for ischemia. See below.
Recalibrating…HEART Score with High-Sensitivity Troponin T
Spoon Feed
A recalibrated HEART score ≤ 3 utilizing hs-cTnT ruled out MACE (adjudicated type 1 MI, unplanned coronary revascularization, and all cause death) at 30 days at a sensitivity of 98.5% and NPV of 99.7% with the ability to discharge 46.5% of patients in this cohort.
Source
HEART Score Recalibration Using Higher Sensitivity Troponin T. Annals of emergency medicine, S0196-0644(23)00313-X. 10 Jun. 2023, doi:10.1016/j.annemergmed.2023.04.024