Angioplasty vs. Optimal Medical Treatment?

NEW ORLEANS, Louisiana (AP) -- More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.

• Angioplasty no more effective than drug therapy in reducing chest pain

• Angioplasty didn't save lives or prevent heart attacks in non-emergencies

• Only one-third of people treated with drugs later needed angioplasty, bypass

...

These results were presented at this years ACC meeting.

The study will be published in the April 12th issue of NEJM, so stay tuned!

Obtained from www.cnn.com

How Much Do I Tell My Patient To Eat?

Based on a 2000 KCal Diet /day, the dietary requirements for a healthy adult are as follows:

Carbohydrates: 45 %-65 % (limit from sweets)

Proteins: 10 %-35 % - 50 to 175 grams

Fat: 20 %-35 % - 40 to 70 grams

Saturated Fat: 10% - 20 grams

Trans Fat: 1% - 2 grams

Cholesterol: 300 milligrams

Fiber: Women - 21 to 25 grams of fiber /day; Men - 30 to 38 grams of fiber /day

Note: Prunes are an excellent source of this, and each has about 2.5 grams of fiber per prune

Sodium: 1,500 - 2,400 milligrams of sodium /day

***Obtained from www.mayoclinic.com***

Mechanism of Action-Amiodarone

During normal sinus rhythm (Panel A), myocardial activation is initiated in the sinus node, with a resulting coordinated wavefront of depolarization that spreads across both atria (arrows) to the atrioventricular node and specialized conduction system (green). Atrial fibrillation (Panel B) is triggered by atrial premature depolarizations arising in the region of the pulmonary veins (red asterisk) and propagates in an irregular and unsynchronized pattern (arrows). The resulting pattern of ventricular activation is irregular (as shown on the electrocardiographic recording). Amiodarone (Panel C) has several electrophysiological effects. Chief among these in the control of atrial fibrillation is the effect on the potassium channel blockade, which slows repolarization, thus prolonging the action potential and the refractoriness of the myocardium. Waves of depolarization are more likely to encounter areas of myocardium that are unresponsive; thus, propagation is prevented. Although the prolongation of the action potential is most apparent on the electrocardiogram as an effect on the ventricular myocardium (prolonged QT interval), a similar effect occurs in the atria.

NEJM. Zimetbaum 356 (9): 935, Figure 1 March 1, 2007