Heart Failure with Preserved Ejection Fraction (HFpEF) – NEJM

Notes from NEJM Review Article:  Redfield MM. (2016), Heart Failure with Preserved Ejection Fraction Case:  73 yo woman seen for hospital f/u after admission for AF with RVR and pulm edema.  She c/o fatigue and DOE. Cr 1.4, eGFR 37, NT-proBNP 300.  Echo EF 70% with nl LV dimensions.  Elevated LA pressure and pulm arterial… Continue reading Heart Failure with Preserved Ejection Fraction (HFpEF) – NEJM

Alpha-blockers aid in passage of kidney stones (meta-analysis)

Meta-analysis: alpha blockers effective for kidney stonesClinical Question:In patients with kidney stones (ureteric calculi), is treatmentwith an alpha blocker effective in improving passage rate and decreasingpain?Bottom Line:Although a recent large study found no benefit to alpha blocker treatment (Lancet 2015;386:341-49), this meta-analysis of 55 studies found a benefit to using alpha blockers to increase the… Continue reading Alpha-blockers aid in passage of kidney stones (meta-analysis)

Asymptomatic Hypertensive Urgencies Can Be Managed Outpatient

Retrospective study of 59,000 patients presenting to outpatient setting with severe asymptomatic hypertension. No difference between those sent to the ED vs those managed as outpatients in: Major adverse CV events Uncontrolled HTN 6 mos later Only difference - those who went to the ED were hospitalized more often. Take-away:  Asymptomatic severe hypertension can be… Continue reading Asymptomatic Hypertensive Urgencies Can Be Managed Outpatient

Mild Hypertension – British Medical Journal

The key quotation:  "No trials have examined primary prevention of cardiovascular disease events among patients exclusively with mild hypertension. Given that thousands of patients would need to be followed for many years to accrue enough events to draw conclusions about mortality, it is unlikely that a placebo controlled trial assessing treatment of mild hypertension will… Continue reading Mild Hypertension – British Medical Journal

Treatment of Ascites

Presentation in rounds by Dr Amy Hills: Prognosis:  Treatment does not improve survival.  But...it makes the patient feel better, may lower risk of SBP and cellulitis of the abdomen, and the patient expends fewer calories heating the fluid! Treatment:  Consider diagnostic/therapeutic paracentesis. Stop drinking EtOH! < 2 gram NaCl restriction Fluid restrict if Na <… Continue reading Treatment of Ascites

Direct Oral Anticoagulants vs Vitamin K Antagonists in Chronic Renal Failure

​Ann Intern Med. 2016;165:JC43. doi:10.7326/ACPJC-2016-165-8-043 This systematic review and meta-analysis examined 9 randomized, controlled trials comparing direct oral anticoagulants (DOACs) with warfarin (with or without a lovenox bridge) in patients with atrial fibrillation or venous thromboembolism. It found that DOACs are associated with less intracranial hemorrhage than warfarin in patients with creatine clearance (CrCl) levels… Continue reading Direct Oral Anticoagulants vs Vitamin K Antagonists in Chronic Renal Failure