Blog

■ Transcatheter aortic valve implantation for severe aortic stenosis

A Garg, S Verna

CMAJ 2019, vol 191 (5): E134

1 – Transcatheter aortic valve implantation is first-line therapy for high-risk patients with severe symptomatic aortic stenosis

2 – The procedure should be performed at a dedicated centre of excellence specializing in treatment of valvular heart disease

3 – There are unique postoperative risk associated with transcatheter aortic valve implantation

4- While thromboprophylaxis is recommended after transcatheter replacement, the choice of therapy is controversial

5 – Routine endocarditis prophylaxis is recommended for patients with na implanted transcatheter aortic valve

https://www.cmaj.ca/content/191/5/E134

 

■ E-cigarettes

M Allosh, J Johnston, B Harvey

CMAJ 2019, vol 191 (41): E1136

1. E-cigarette use is increasing in Canada, especially among youth

2 – E-cigarette use is strongly associated with the initiation and ongoing use of cigarette smoking

3 – E-cigarettes are na additional smoking cessation tool

4 – E-cigarettes are unregulated products with potentially dangerous health effects

5 – Clinicians should ask about e-cigarette use

https://www.cmaj.ca/content/191/41/E1136

 

■ Proprotein convertase subtilisin-kexin type 9 (PCSK9)

D Leong, P E Wu

CMAJ 2019, vol 191 (32): E894

1 – Protein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a new class of low-density lipoprotein (LDL-c) lowering medications

2 – PCSK9 inhibitors have been shown to improve cardiovascular outcomes

3 – PCSK9 inhibitors are recommended as add-on therapy in patientes at very high risk

4 – PCSK9 inhibitors are well tolerated, but long-term safety data are lacking

https://www.cmaj.ca/content/191/32/E894

 

■ The cardiovascular benefits of low-dosage acetylsalicylic acid

P Koipillai, N S Nishtala

CMAJ 2019, vol 191 (43): E1194

1 – Acetysalicylic acid (ASA) has established benefit in the secondary prevention of cardiovascular disease

2 – The benefit of ASA in the primary prevention of cardiovascular disease is offset by potential bleeding risks

3 – Patients with diabetes, despite their increased cardiovascular risk, have questionable benefit from ASA used for primary prevention

4 – Perioperative use of ASA in noncardiac surgery is unlikely to reduce the risk of myocardial infarction or venous thromboembolism

5 – Acetysalicylic acid should be used patients with myocardial injury or ischemia after noncardiac surgery

https://www.cmaj.ca/content/191/43/E1194

 

■ Direct oral anticoagulante and the bleeding patients

B Wood, M Sholberg, A Ackery

CMAJ 2016, vol 188 (3): 215

1 – Direct oral anticoagulante agentes are now routinely used for the prevention of stroke in nonvalvular atrial fibrillation

2 – Risk of bleeding with direct oral anticoagulantes is lower than with vitamin K antagonists, but varies by site

3 – Direct oral anticoagulants are characterized by rapid onset of action and short half-live

4 – Direct oral antiagulants variably affect standard clot-based assays

5 – Idarucizumab has recently been approved by the US Food and Drug Administraton to reverse the activity of dabigatran

https://www.cmaj.ca/content/188/3/215

 

■ Postpartum hypertension

K Powles, S Gandhi

CMAJ 2017, vol 189 (27): E913

1 – Blood pressure should be measured three to six day after delivery

2 – Onset of preeclampsia can be postpartum

3 – Treatment is recommended if high blood pressure is presente persistently (systolic > 140 and/or diastolic > 90 mmHg)

4 – Pospartum hypertension may persist for several weeks

5 – Postpartum hypertension can be treated safely during breastfeeding

https://www.cmaj.ca/content/189/27/E913

 

■ Screening for fetal congenital heart disease

A Pham, M Melchior

CMAJ 2017, vol 189 (12): E468

1 – Congenital heart disease is the most common caue of infant death and morbidity from birth defects

2 – Referral for fetal echocardiography should bem ade in cases where nuchal tanslucency is above the 99th percentile

3 – Most cases of congenital heart disease occur n low-risk populations

4 – Both maternal and fetal factors may prompt referral for fetal echocardiography

5 – Some lesions can be treated antenatally

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367993/

 

■ Cardiopulmonary resuscitation

F Khan, C Vaillancourt

CMAJ 2017, vol 189 (1): E25

1 – Chest compressions during cardiopulmonar resuscitation should be fast pushes

2 – Perischock pauses should be limited to improve survival

3 Rescuers may adopt an interrrupted or continuous CPR strategy

4 – Vasopressin offers no advantage over epinephrine in cardiac arrest

5 – A target temperature should be maintained in the postcardiac arrest period

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224950/

 

■  Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601

Tel: 33245518

CRMMG: 7026

Email: pfleite1873@gmail.com

Data: Fev 2020

■ Penicillin allergy

D J McCullagh and D K Chu

CMAJ 2019, vol 191 (8): E231

1 – Penicillin allergy is commonly reported, but 9 out of 10 times, penicillin will be tolerated if administered

2 – The label of penicillin allergy is bad for patients and the health care system

3 – Patients reporting penicillin allergy can be easily risk stratified to determine whether they require specialist evaluation

4 – Penicillin allergy is lost over time, with resolution in 80% of people over 10 years, and in 50% over 5 years

5 – Allergy referral and testing is vastly under used, but is safe, accurate, rapid and cost-effective

https://www.cmaj.ca/content/191/8/E231

 

■ Vaccine alllergy

D K Chu, Z Abdurrahman

CMAJ 2019, vol 191 (14): E395

1 – Immunoglobulin E (IgE)-mediated vaccine allergies are uncommon, manifesting within minutes as urticaria, angioedema, wheeze or anaphylaxis

2 – The most common adverse events of vacines are fever, local pain or irritation, and local redness or swelling, whic are not signs of allergy

3 – Patients with egg allergy can be safely vaccinated with several vacines without any special

4 – Vaccine allergies are typically unpredictable specific to a single vaccine

5 – Even if patients are truly allergic to a vaccine, allergists can often safely vaccinate them

https://www.cmaj.ca/content/191/14/E395

 

■ Eosinophilic esophagitis

T Jevalingam, S C Grover

CMAJ 2018, vol 190 (17): E542

1 – Eosinophilic esophagitis is becoming more common

2 – Eosinophilic esophagitis should be suspected in patients presenting with dysphagia or food bolus obstruction

3 – Endoscopic findings alone are not suficiente to make a diagnosis of eosinophilic esophagitis

4 – Proton pump inhibitors should be prescribed for a histologic finding of esophageal esosinophilia

5 – Topical steroids and elimination diets are the mainstays of therapy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5929894/

 

■  Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601

Tel: 33245518

CRMMG: 7026

Email: pfleite1873@gmail.com

Data: Fev 2020