micro-community-banner
 
Profile Image
  • Image/Video
  • Saved

Yesterday
case study

Patient Background:

A 39-year-old male presented with exertional dyspnea, orthopnea, and shortness of breath. He was an active smoker with a history of pulmonary edema 10 months prior. On admission, his blood pressure was 120/70 mmHg, and he was receiving bisoprolol, ramipril, and furosemide. Though family history was unspecified, aortic dilation prompted consideration of first-degree relative screening, as recommended in bicuspid valve disease.

Assessment & Diagnosis:

Transthoracic echocardiography revealed severe aortic regurgitation (grade 4+), a left ventricular end-diastolic diameter of 65 mm, and preserved ejection fraction of 56%. The ascending aorta measured 54 mm. Preoperative imaging suggested a bicuspid aortic valve; however, intraoperative inspection revealed a rare pentacuspid aortic valve with five variably sized cusps, some exhibiting partial fusion. The final diagnosis was severe aortic regurgitation and ascending aortic aneurysm due to a pentacuspid valve anomaly.

  1. Why is pentacuspid aortic valve important in the workup of severe AR?
  2. How does early surgical intervention influence long-term outcomes in such patients?
Profile Image
  • Saved

2d
The Western and Chinese exercise training for blood pressure reduction among hypertensive patients: An overview of systematic reviews - PubMed

The Western and Chinese exercise training for blood pressure reduction among hypertensive patients: An overview of systematic reviews - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36946438/

Hypertension remains the world's leading cause of premature death. Interventions such as exercise, diet modification, and pharmacological therapy remain the mainstay of hypertension treatment. Numerous systematic reviews and meta-analyses demonstrated...

This overview of 39 systematic reviews found both Western (aerobic, resistance) and Chinese (Tai Chi, Qigong, Baduanjin) exercises significantly reduce blood pressure, demonstrating comparable antihypertensive benefits and suitability for middle-aged and elderly patients.

Profile Image
  • Saved

1w
Hepatic Venous Outflow Reconstruction Directly Into the Right Atrium - PubMed

Hepatic Venous Outflow Reconstruction Directly Into the Right Atrium - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/31801445/

During the natural course of the disease, venous collaterals form as chronic thrombosis extends into the vena cava. The vena cava can be safely resected in these patients to facilitate...

In three Budd–Chiari syndrome patients undergoing living-donor liver transplantation, hepatic venous outflow was successfully reconstructed directly into the right atrium, enabling effective drainage without vena cava replacement and showing long-term graft patency.

Profile Image
  • Saved

1w
Prioritizing GDMT: Early initiation and risk stratification transform heart failure outcomes.

Heart failure (HF) remains a leading cause of morbidity and mortality, but timely initiation and optimization of guideline-directed medical therapy (GDMT) can meaningfully improve outcomes. In patients with HFrEF, comprehensive quadruple therapy—including a RAAS inhibitor, beta-blocker, mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor—can reduce mortality by over 70%. Trials such as STRONG-HF have demonstrated that early, in-hospital or post-discharge uptitration lowers rehospitalization and death rates.

Comorbidities—particularly the cardiovascular–kidney–metabolic overlap—complicate management but highlight the need for individualized care. RAAS inhibitors reduce intraglomerular pressure and proteinuria. SGLT2 inhibitors decrease glucose reabsorption and myocardial stress, benefiting patients with or without diabetes. Nonsteroidal MRAs may also reduce renal decline and cardiovascular events in patients with type 2 diabetes and CKD. Therapy decisions must consider renal function, potassium levels, and blood pressure.

Risk stratification with tools such as LVEF, NT-proBNP, and NYHA class can guide therapy intensity and follow-up. For example, elevated NT-proBNP levels post-GDMT initiation are prognostic and can help refine monitoring strategies.

Multidisciplinary HF programs—including pharmacist-led titration, digital tools, and remote monitoring—can reduce readmissions by up to 40% and mortality by 25%.

How can your team best use pharmacist-led or digital titration to accelerate GDMT optimization in HFrEF? What strategies have been effective in overcoming therapeutic inertia and improving adherence?

Profile Image
  • 1w
    These medications are sometimes expensive and the regimens can be complex for patients. A call from a pharmacist to the patient once they are home to confirm what Show More
  • 1w
    Patients with HFrEF are complex. Yes it takes a team approach. All these medications require close follow up with renal function monitoring not to mention the cost and prior authorization Show More

Show More Comments

  • Saved

1w
Bridging gaps in CHD care: pharmacologic advances and research needs in congenital heart disease

Congenital heart disease (CHD) remains the leading cause of death from birth defects worldwide. While survival exceeds 90% in high-income countries, many patients—particularly where surgery is limited—rely on pharmacologic management. Treatments often reflect adult heart failure regimens, targeting shared mechanisms like neurohormonal activation and cardiac remodeling.

Highlights:

  • ACE inhibitors, ARBs, beta-blockers, and diuretics to manage heart failure and ventricular dysfunction
  • Endothelin receptor antagonists, PDE-5 inhibitors, prostaglandins, and sGC stimulators for pulmonary arterial hypertension (PAH)
  • Digoxin, antiarrhythmics, and NSAIDs as adjunctive therapies for symptoms, arrhythmias, and ductal patency
  • Up to 85% of cardiovascular drugs in children are used off-label due to lack of pediatric-specific trials

What Sets This Study Apart:

This review consolidates pharmacologic strategies tailored to the complexity of CHD across age groups and comorbidities. It emphasizes treatment rationale, dosing nuances, and highlights critical evidence gaps that affect pediatric prescribing.

Limitations:

Current practice leans heavily on adult data. Clinical trials for pediatric CHD are scarce (<0.45% of NIH-funded CV trials), limiting evidence-based dosing, safety, and outcome data in children.

How do you balance limited pediatric trial data with the need for evidence-based care in CHD? What role could personalized, genomics-driven approaches play in shaping future outcomes?

Profile Image