Statin Use in the Elderly – Start or Stop? - Frankly Speaking Ep 207
Play • 11 min

Credits: 0.25 AMA PRA Category 1 Credits™

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Overview: Data are limited regarding statin therapy for primary prevention of atherosclerotic cardiovascular disease in adults 75 years and older. During this episode we will review recent studies on the use of statins in elderly patients and discuss how to consider this data in your clinical practice.

Guest: Robert Baldor, MD, FAAFP

Music Credit: Richard Onorato

The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
#259 Addiction Medicine Triple Distilled
Let's recap our favorite addiction medicine pearls! We cover the treatment of alcohol use disorder, opioid use disorder and discuss strategies surrounding the management of long-term opioid therapy. Please share your favorite addiction medicine pearls with us that we may have forgotten in the comments or by tagging us on Twitter @thecurbsiders. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | | Free CME! Credits * Producers: Carolyn Chan MD; Nora Taranto MD * Infographics: Hannah R Abrams; Justin Berk MD, MPH, MBA; Carolyn Chan MD; Nora Taranto MD * Writer and Cover Art: Carolyn Chan, MD * Hosts: Carolyn Chan MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP * Editor: Justin Berk MD (written materials); Clair Morgan of Sponsor: Panacea Financial This episode is supported by Panacea Financial, digital banking built for doctors, by doctors. At Panacea Financial, you can have your own free personal banker and a support team that works around the clock- just like you do. Open your free checking account today at Panacea is also excited to announce their “Match Day Giveaway.” $500 will be awarded to five medical students entering the match in 2021. Entry is free, and students can enter the giveaway on their website until March 31, 2021. Winners will be selected randomly on April 1st, 2021. No purchase necessary for entry. Go to today to learn more. Panacea Financial, a Division of Sonabank, Member FDIC Partner: The Cribsiders Pediatric Medicine Podcast A Pediatric Podcast here to feed pediatric knowledge food to your adult-sized brain hole & provide weight-based dosings of fun. New episodes drop every other Wednesday! CME Partner: VCU Health CE The Curbsiders partner with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit to claim credit. Time Stamps * Intro, disclaimer 00:00 * Alcohol Use disorder (inpatient and outpatient management) 03:50 * Sponsor -Panacea Finanicial 24:00 * Partner -The Cribsiders Pediatric Medicine Podcast * Chronic Pain and Opioid Therapy (prescribing buprenorphine; microdosing) 25:30 * Benzo Tapers 46:11 * Outro
50 min
Cardionerds: A Cardiology Podcast
Cardionerds: A Cardiology Podcast
104. Nuclear and Multimodality Imaging: Anomalous Coronary Arteries & Myocardial Bridges
CardioNerd Amit Goyal is joined by Dr. Erika Hutt (Cleveland Clinic general cardiology fellow), Dr. Aldo Schenone (Brigham and Women’s advanced cardiovascular imaging fellow), and Dr. Wael Jaber (Cleveland Clinic cardiovascular imaging staff and co-founder of Cardiac Imaging Agora) to discuss nuclear and complimentary multimodality cardiovascular imaging for the evaluation of abnormal coronary anatomy including anomalous coronary arteries and myocardial bridges. Show notes were created by Dr. Hussain Khalid (University of Florida general cardiology fellow and CardioNerds Academy fellow in House Thomas). To learn more about multimodality cardiovascular imaging, check out Cardiac Imaging Agora! Collect free CME/MOC credit just for enjoying this episode!  CardioNerds Multimodality Cardiovascular Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll Subscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show Notes & Take Home Pearls Five Take Home Pearls Anomalous coronaries are present in 1-6% of the general population and predominantly involve origins of the right coronary artery (RCA). Anomalous origination of the left coronary artery from the right sinus, although less common, is consistently associated with sudden cardiac death, especially if there is an intramural course. Sudden cardiac death can occur due to several proposed mechanisms: (1) intramural segments pass between the aorta and pulmonary artery making them susceptible to compression as the great vessels dilate during strenuous exercise; (2) an acute angle takeoff of the anomalous coronary can create a “slit-like” ostium making it vulnerable to closure. Anomalous left circumflex arteries are virtually always benign because the path taken behind the great vessels to reach the lateral wall prevents vessel compression.Myocardial bridging (MB) is a congenital anomaly in which a segment of the coronary artery (most commonly, the mid-left anterior descending artery [LAD]) takes an intramuscular course and is “tunneled” under a “bridge” of overlying myocardium. In the vast majority of cases, these are benign. However, a MB >2 mm in depth, >20 mm in length, and a vessel that is totally encased under the myocardium are more likely to be of clinical significance, especially if there is myocardial oxygen supply-demand mismatch such as with tachycardia (reduced diastolic filling time), decreased transmural perfusion gradient (e.g. in myocardial hypertrophy and/or diastolic dysfunction), and endothelial dysfunction resulting in vasospasm.PET offers many benefits over SPECT in functional assessment of MB including the ability to acquire images at peak stress when using dobutamine stress-PET, enhanced spatial resolution, and quantification of absolute myocardial blood flow. For pharmacologic stress in evaluation of MB, we should preferentially use dobutamine over vasodilator stress. Its inotropic and chronotropic effects enhance systolic compression of the vessel, better targeting the pathological mechanisms in pearl 2 above that predispose a MB to being clinically significant.CCTA can help better define the anatomy of MB as well as anomalous origination of the coronary artery from the opposite sinus (ACAOS), help with risk stratification, and assist with surgical planning.Instantaneous wave-free ratio (iFR) measures intracoronary pressure of MB during the diastolic “wave-free” period – the period in the cardiac cycle when microvascular resistance is stable and minimized allowing the highest blood flow. This allows a more accurate assessment of a functionally significant dynamic stenosis than fractional flow reserve (FFR) – which can be falsely normal due to systolic overshooting. Read more hidden text Detailed Show Notes What are some examples of abnormal coronary anatomies and how often do they lead to clinical events?
23 min
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