Thursday, September 25, 2014

American College of Cardiology removes one of its choosing wisely recommendations in light of recent evidence

From an ACC news release:

In response to new science showing that complete revascularization of all significantly blocked arteries leads to better outcomes in some heart attack patients, the American College of Cardiology has withdrawn its Choosing Wisely recommendation that patients and caregivers examine whether this practice is truly necessary.

We've learned well the lessons against hasty adoption following early evidence. This is the flip side. We must be very cautious about putting something on the “do not” list. I think the campaign has been a little hasty in some of its recommendations.

Via Cardiobrief.

Cardiac involvement in mixed connective tissue disease

From a recent review:

616 patients were included. Prevalence of cardiac involvement varied from 13% to 65% depending on patient selection and method used for detection. Pericarditis was the most common cardiac diagnosis with a prevalence of 30% and 43% in two prospective studies. Non-invasive cardiac tests, including electrocardiogram and echocardiogram, detected subclinical cardiac abnormalities in 6%–38% of patients. These abnormalities included conduction abnormalities, pericardial effusion and mitral valve prolapse. Diastolic dysfunction and accelerated atherosclerosis were well-documented in a case–control study. Three prospective studies revealed an overall mortality of 10.4% over the period of follow-up of 13–15 years. 20% of the mortality was directly attributable to cardiac cause.

Cardiac involvement was common among patients with MCTD though the involvement was often clinically inapparent. Non-invasive cardiac tests might have a role for subclinical disease screening for early diagnosis and timely treatment as cardiac involvement was one of the leading causes of mortality.

Wednesday, September 24, 2014

Cyclobenzaprine (Flexeril) overdose: is it the same as with a tricyclic?

According to this post (with references to back it up) at Academic Life in Emergency Medicine it's not nearly as bad. The anticholinergic toxidrome is present but not the life threatening cardiac arrhythmias or refractory seizures. (I wouldn't discount the possibility of the really nasty stuff if the OD is large).

Exercise your brain and delay cognitive impairment

From a JAMA Clinical Trials Update.