Broken Heart Syndrome

Atherosclerosis in Egyptian mummies

Researchers using a CT scanner have discovered the real mummy’s curse: Hardening of the arteries. More than half the middle-aged and older Egyptian mummies that underwent CT scans earlier this year probably had atherosclerosis, an international team of researchers says.
Their findings cast doubt on the common idea that atherosclerosis is a result of the bad habits and worse diets of modern civilization.

Instead, it may be a byproduct of civilization itself. Large-scale agriculture creates a class of people with lots of rich food and not much physical labor.
That combination has been clogging arteries for millennia.
“We think of atherosclerosis being related to risk factors of modern life, but clearly the disease has been around since before Moses,” said Randall Thompson, a St. Luke’s Hospital cardiologist and a lead researcher on the study.

LA mass

http://www.echojournal.org/video/198/LA-mass

Left atrial myxoma with functional MS.

Elderly female patient with AF, Pulmonary hypertension, Bilateral pleural efuusion.
All the best

A case of CHD; DTGA, ASD, VSD, PDA,...in a 26 days newborn.
See how coronaries are seen.
see how the two vessels are seen as circles. No susage and circle appearance.
Thanks Dr Ghada, My Supervisor for confirming my diagnosis.

Find more videos like this on CardiologyRounds.com

Relation of Disease Pathogenesis and Risk Factors to Heart Failure With Preserved or Reduced Ejection Fraction

Insights From the Framingham Heart Study of the National Heart, Lung, and Blood Institute

Douglas S. Lee, MD, PhD; Philimon Gona, PhD; Ramachandran S. Vasan, MD; Martin G. Larson, ScD; Emelia J. Benjamin, MD, ScM; Thomas J. Wang, MD; Jack V. Tu, MD, PhD; Daniel Levy, MD
From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.V.T.); University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Framingham Heart Study of the National Heart, Lung, and Blood Institute, Framingham, Mass (P.G., R.S.V., M.G.L., E.J.B., T.J.W., D.L.); Department of Mathematics and Statistics, Boston University, Boston, Mass (P.G., M.G.L.); Cardiology Section and Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Mass (E.J.B., R.S.V.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (T.J.W.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (J.V.T.); and Center for Population Studies of the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.).
Correspondence to Daniel Levy, MD, Director, Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702-5827. E-mail levyd@nih.gov
Received August 19, 2008; accepted April 6, 2009.
Background— The contributions of risk factors and diseasepathogenesis to heart failure with preserved ejection fraction(HFPEF) versus heart failure with reduced ejection fraction(HFREF) have not been fully explored.
Methods and Results— We examined clinical characteristicsand risk factors at time of heart failure onset and long-termsurvival in Framingham Heart Study participants according toleft ventricular ejection fraction $≤$ 45% (n=314; 59%) versus >45%(n=220; 41%) and hierarchical causal classification. Heart failurewas attributed to coronary heart disease in 278 participants(52%), valvular heart disease in 42 (8%), hypertension in 140(26%), or other/unknown causes in 74 (14%). Multivariable predictorsof HFPEF (versus HFREF) included elevated systolic blood pressure(odds ratio [OR]=1.13 per 10 mm Hg; 95% confidence interval[CI], 1.04 to 1.22), atrial fibrillation (OR=4.23; 95% CI, 2.38to 7.52), and female sex (OR=2.29; 95% CI, 1.35 to 3.90). Conversely,prior myocardial infarction (OR=0.32; 95% CI, 0.19 to 0.53)and left bundle-branch block QRS morphology (OR=0.21; 95% CI,0.10 to 0.46) reduced the odds of HFPEF. Long-term prognosiswas grim, with a median survival of 2.1 years (5-year mortalityrate, 74%), and was equally poor in men and women with HFREFor HFPEF.
Conclusions— Among community patients with new-onset heartfailure, there are differences in causes and time-of-onset clinicalcharacteristics between those with HFPEF versus HFREF. In peoplewith HFREF, mortality is increased when coronary heart diseaseis the underlying cause. These findings suggest that heart failurewith reduced left ventricular systolic function and heart failurewith preserved left ventricular systolic function are partiallydistinct entities, with potentially different approaches toearly detection and prevention.

I LOOK I SEE 2

First cartoon video from I Look, I See 2 performed by Rashid A. Bhikha who sung on the original I Look, I See too.

I Look I See is an album released by Yusuf Islam in 2003 which was aimed at children. It contained nine songs, and each song was followed by a brief spoken word piece which told of the deeds of the Prophets of Islam, the Five Pillars of Islam and other Islamic practices.

A Thousandth Opinion

From P Coelho Blog:

A Thousandth Opinion (by Albert Lim Kok Hoo)

I know a man who has seen a thousand doctors. Let us call him Thomas. He is 80 years old but even so, a thousand is a huge number. In a year, he would have seen 12 new doctors on the average. A thousand different doctors means perhaps 20,000 consultations. Sometimes Thomas sees three different doctors in one afternoon.
Some of Thomas’s friends are doctors. Some of his doctors become his friends. His doctors range from the junior to the senior, from those in government hospitals to those in private practice, from generalists to specialists. Men, women, foreigners, graduates from local universities; he has seen them all. Sometimes he sees them just to measure his blood pressure.
Sometimes it is for a more serious matter like an unexplained chest pain. He has spent about $230,000 in his lifetime on doctor visits, blood tests, medications, X-rays, scans and  minor surgeries.
He has no regrets. Others may splurge on flashy cars or the services of a sommelier, but for Thomas it is doctors, doctors and more doctors. Sadly, Thomas was diagnosed with lung cancer recently and was referred to me. I wonder how many more oncologists he has seen or will be seeing.
Thomas came across as a well adjusted gentleman. He did not exhibit any verbal or physical tic. He spoke well. He gave his medical history clearly and answered most of my questions willingly and appropriately. Having gained his trust, I decided to explore his need to see so many doctors. He was forthright about it. He is afraid to die.
So many of us, with or without cancer, are not willing to admit to our fear of death. We couch our fear like this: “Doctor, I am not afraid to die but I fear the process of dying.” Others of a more poetic bent will say, “Oh, death, where is thy sting?” It is a badge of honor we proudly wear on our sleeves.
Thomas was afraid of death, and he was not afraid to admit it. That’s courage. He was going to do his best to postpone it. Of course, seeing a thousand doctors does not help. It may even be harmful. Conflicting opinions lead to confusion and anxiety. Excessive and unnecessary X-rays and CT scans increase the chance of radiation- induced cancer.
Apart from his fear of death, Thomas also disclosed a distrust of doctors. He was seeking as many opinions as possible before deciding on treatment. He had his doubts. Now you know why I gave Thomas his moniker.
Is Thomas suffering from hypochondriasis? The condition is characterised by fears that minor bodily symptoms may indicate a serious illness. The hypochondriac constantly examines himself; self-diagnosis becomes a preoccupation. He expresses doubt and disbelief in the doctor’s diagnosis. Thomas has some traits of a hypochondriac but that is too easy a label to stick on him. Thomas had a CT scan of his chest two years ago that disclosed a shadow in his lung. He was treated for pneumonia. The possibility of cancer was excluded when most of the shadow disappeared with a course of antibiotics. The doctors should have gone the extra mile to exclude cancer with a PET/CT scan and a biopsy.
Some may diagnose Thomas with thanatophobia — an undue obsession with death (especially one’s own) to the extent that it becomes psychologically crippling. Again, this would be too convenient a label. Thomas is a successful entrepreneur and is socially adept.
I really don’t know. We tend to medicalise every little symptom and discomfort. From an infant’s excessive crying to teenage angst to a wage earner’s blues. There is a pill for everything: insomnia, erectile dysfunction and the sadness of bereavement. Perhaps Thomas has the time and money to see many doctors and he feels good doing this. It is therapeutic for him, if you can forgive my use of the word. It may be no different from some others I know who spend as much as Thomas does on audiovisual systems or eating unmentionable parts of endangered animals.
I shall help Thomas fight his cancer. I will dissuade him from unnecessary blood tests and scans. I will not judge him. Most of all, I will not medicalize his fear of death. It is about being human. There is no pill for it.

Albert Lim Kok Hooi is an oncologist based in Kuala Lumpur

What do you think?

Do not start beta blocker on day of surgery.

Originally published in
http://www.medpagetoday.com/Surgery/ThoracicSurgery/16749

but, do not start beta blocker on day of surgery.

High-risk patients who are not taking beta-blockers should have beta-blocker therapy started well before scheduled cardiovascular surgery, with doses titrated up as the surgery date approaches, according to updated guidelines released today by the American College of Cardiology and American Heart Association.