Heart Failure Treatment Acronyms

Medications don’t cure people. Acronyms do.

Well, maybe medications do a little bit.

Maybe.

Anyway, here’s how to remember how to treat acute heart failure in an examination setting.

LMNOP

  • Lasix
  • Morphine
  • Nitrates
  • Oxygen
  • Position

POND

  • Position and positive pressure ventilation
  • Oxygen
  • Nitrates
  • Diuretics

References

  1. SOCMOB Blog. (2017). Evidence Based Management of Acute Heart Failure: Forget LMNOP, think POND! – SOCMOB Blog. [online] Available at: http://socmob.org/2013/04/evidence-based-management-of-acute-heart-failure-forget-lmnop-think-pond/ [Accessed 24 Dec. 2017].
  2. Time of Care. (2017). LMNOP – For Congestion in Acute Decompensated Hear Failure. [online] Available at: https://www.timeofcare.com/lmnop-for-congestion-in-acute-decompensated-hear-failure/ [Accessed 24 Dec. 2017].
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Atrioventricular Valves

Let’s explore the inner workings of the heart in a highly summarised form!

Tricuspid: right, which is commonly the dominant hand.

Mitral: left. The only bicuspid valve, as the other three heart valves all have three cusps or leaflets. In normal situations, anyway!

ACE Inhibitors

Let’s learn about a good friend: ACE inhibitors!

Pertinent Facts

  • class of medication
  • used to treat hypertension
  • end in -pril
  • stop ACE from working its magic on the angiotensin I –> angiotensin II conversion
  • side effects: dry cough (due to bradykinin), hyperkalaemia (because of less aldosterone), angioedema (rare and life-threatening)
  • ARBs are an alternative

Further Details

Renin-Angiotensin-Aldosterone System

Renin (from those pesky organs called kidneys) turns angiotensinogen (also known as renin substrate) into angiotensin I.

ACE (whose full title is angiotensin-converting enzyme) turns angiotensin I into angiotensin II.

Angiotensin II has numerous magical properties: vasoconstriction, stimulating aldosterone release and more…so magical!

Dry Cough, Courtesy Of Bradykinin

Angiotensin II normally clears bradykinin. When ACE inhibitors block that, bradykinin builds up and makes the person cough.

Hyperkalaemia, Due To Vicious Subjugation Of Aldosterone

Aldosterone retains sodium and kicks out potassium. Take that, distal kidney parts! That’s where it acts.

Spironolactone, a medication well-known for its alluring gynaecomastia properties, is an aldosterone antagonist. It’s a potassium-sparing diuretic, which means it helps pass more urine without destroying the person’s blood potassium level to low, low amounts.

Let’s return to aldosterone itself, however. Aldosterone is like a vindictive, electrolyte-discriminating landlord that takes in sodium but evicts potassium from the rental property. It’s the excessively muscly security guard who stops that drunken, disorderly potassium from trying to enter the blood club.

Given the above, inhibition of aldosterone causes the opposite of its normal effects: not ejecting as much potassium from the system. Too much potassium is in the nightclub of your blood! That means hyperkalaemia!

Therefore, anything that stops the triggering of aldosterone creates a risk of hyperkalaemia.

But an ACE inhibitor stops angiotensin II from being formed! And that indirectly reduces the triggering of aldosterone that otherwise would have occurred! Hyperkalaemia might ensue! Chaos everywhere!

That explains one of the potential side effects of ACE inhibitors.

Angioedema Is Serious And Bad

If an ACE inhibitor triggers this, the patient can be switched to an ARB, which is an angiotensin II receptor blocker. It achieves a similar effect without as much risk of the side effects of ACE inhibitors.

Well, well, well, ACE inhibitors. We’ve figured you out now!

References

  1. CV Pharmacology. (2017). CV Pharmacology | Angiotensin Converting Enzyme (ACE) Inhibitors. [online] Available at: http://cvpharmacology.com/vasodilator/ACE [Accessed 30 Jul. 2017].
  2. Howarth, D. A. (2017). RACGP – ACE inhibitor angioedema: a very late presentation. [online] racgp.org.au. Available at: http://www.racgp.org.au/afp/2013/december/ace-inhibitor-angioedema/ [Accessed 30 Jul. 2017].
  3. Uptodate.com. (2017). Medline ® Abstract for Reference 63 of ‘ACE inhibitor-induced angioedema’. [online] Available at: https://www.uptodate.com/contents/ace-inhibitor-induced-angioedema/abstract/63?utdPopup=true [Accessed 30 Jul. 2017].

What If You Were An Accountant?

Have you ever thought about dropping out of medical school? Have you ever felt that it’s all just too hard?

Perhaps it’s the night before your big multiple-choice examination. You suddenly realise that guessing C isn’t as solid a strategy as you once thought it was.

No! Your world comes crashing down.

You then do the unthinkable; you idly dream about how easy life would be if you were in some other profession. Wouldn’t engineering or law be nice?

https://s-media-cache-ak0.pinimg.com/736x/4d/88/1a/4d881a6bbf975844e23cb44d55d2e46f.jpg

“Oh! If I’d gone and worked in management consulting instead, I’d be rich by now!”

“I could have been a professional Morse code translator, but I chose to study medicine. I would have been so loaded if I’d done that instead of going through medical school for all these years.”

It’s not uncommon to hear people say things like this. The presumption is that life would have been just as successful, if not even more so, in some alternate leg of reality.

Unfortunately, the truth isn’t so simple.

Your unrequited love

Let’s talk about romance for a second.

The person you’re interested in, stalking or uncomfortably fantasising about performs some tiny action, like saying hello to you. What does that mean? WHAT DOES THAT MEAN?!

Nothing, really. But it becomes over-interpreted by a lot of people.

Even if you’ve been married for 40 years, you never fully know what another person is thinking. Despite that, many singletons will still resort to detective work, insisting on picking apart the complex signals that are supposedly being transmitted to them.

Example 1

Scenario: He or she texted you back with a playful emoticon.

Over-analytical interpretation: HE OR SHE IS JUST SO INTO YOU. HE OR SHE IS INTENTIONALLY USING PICTORIAL COMMUNICATION TO EXPRESS THIS DEEP CONNECTION.

Actual meaning: He or she texted you back with a playful emoticon.

Example 2

Scenario: He or she lightly brushed your hand.

Over-analytical interpretation: THERE IS NO WAY IT WAS AN ACCIDENT. HE OR SHE WAS SUBTLY DECLARING HIS OR HER UNDYING LOVE AND THIS MEANS HE OR SHE IS THE ONE. YOU SHOULD START PLANNING THE WEDDING NOW.

Actual meaning: He or she lightly brushed your hand.

The lesson

Event A having occurred means that Event A occurred. Anything else is additional inference at best or unfounded assumption at worst.

Medicine is your reality

In the same way, being a doctor does not automatically mean that you’re smart or that you could do any other job. Passing medical school means you were able to pass medical school. That’s a good achievement in itself, but it doesn’t explicitly prove anything more than that.

The difficult thing is that you can’t quite exist in two jobs at once; simultaneously being a doctor and a lawyer was what made the Crazy Cat Lazy start her cat collection.

http://vignette3.wikia.nocookie.net/simpsons/images/1/18/Newlady.jpg/revision/latest?cb=20071104044016

It began with one.

http://vignette1.wikia.nocookie.net/simpsons/images/0/0a/Leanor2.png/revision/latest?cb=20140320220924

And then it ended with many.

https://tstoaddicts.files.wordpress.com/2014/05/crazy-cat-lady-2.png?w=1345&h=943

Because the what if? situation didn’t occur, it’s hard for anyone to prove you wrong. Maybe you would have been a great computer programmer. Maybe you wouldn’t have been. Maybe you would have been successful enough to invent Facebook before Mark Zuckerberg did. Maybe you would have been terrible, gone bankrupt and lived in a dumpster for 20 years.

You cannot accurately say that you would have earned a vast amount of money in an industry you never actually tried. You just wouldn’t know, because thinking in terms of what if? is not productive or real.

It’s entirely possible that the set of skills you have is best suited to medicine. It’s entirely possible that your personality works in internal medicine but would have been utterly crushed in financial planning. Even if medicine seems to be working out for you, you might well have drowned in some other industry.

Because really, maybe this is where you fit. Maybe this is where your best contribution to society lies.

So remain grateful that you managed to find a place in this great industry. Stay happy for this fit and the fact that it has worked out. Or is working out. Or looks like it will work out.

Health economics considers the best use of scarce medical resources and you, an individual, are still a scarce medical resource. You are special and unique. You snowflake, you. There is only one of you in this world and it’s wonderful that you’ve crawled your way into the industry you fit into.

This is in fact a once-in-a-lifetime opportunity. This is the reality that came true. This is where you belong, not in a world of second-guessing.

In learning the great art of medicine, you have been given an amazing privilege. If not for society’s sake, make the most of it for your own sake.

References

  1. Sheats, J. (2016, June 17). Want to Get Rich and Live a Comfortable Life? You Should Seriously Consider Being a Doctor as Your Path! Interview with Peter Steinberg. Radical Personal Finance [Audio podcast]. Retrieved from http://itunes.apple.com/

Cardiac Nomenclature

When someone is dying in front of you from heart-related causes, there are 2 important things to know.

1. What you can do to help

Your options are simple:

  • Provide First Aid, if you have the qualifications and competency
  • Call an ambulance
  • Stand around gawking uselessly

2. What the condition is called

You must know the name of the affliction. This is so you can shout it out in an authoritative voice at unsuspecting people on the street, in order to sound smart.

In fact, you don’t have to restrict your know-it-all behaviour to the street; you can spontaneously yell “myocardial infarction” or “cardiac arrest” in any setting.

While in line at a coffee shop? Yes.

During a first date? Yes.

While deciding between brands of canned tomatoes at the supermarket? Yes.

It all works. However, remain aware that this might make you appear — quite unjustly — like an eccentric. It might also the reduce likelihood of a second date occurring.

So here’s the question.

What exactly is the difference between myocardial infarction and cardiac arrest? In both cases, the heart fails to some degree.

Myocardial infarction, also known as a heart attack, is from a lack of circulation.

For example, years of junk food lead to atherosclerosis. Fatty rubbish clogs the coronary vessels that supply the heart muscle. The blood supply to the heart becomes blocked.

And while hearts need love, they also need blood. No blood means no nutrients. No nutrients for a long period of time means the deprived heart muscle dies.

Cardiac arrest is from an electrical abnormality. As a result, the heart stops beating.

It’s like when you buy cheap batteries and your remote-controlled car stops working after 10 minutes. The electrical supply just isn’t right.

Myocardial infarction can lead to cardiac arrest, but this isn’t always the case.

References

  1. American Heart Association. (2016, September 19). Heart Attack or Sudden Cardiac Arrest: How Are They Different? Retrieved from http://www.heart.org/
  2. American Heart Association. (2013). Cardiac Arrest vs. Heart Attack. Retrieved from http://cpr.heart.org/

Love Is Like A Heart Attack

Relationships are like atherosclerosis. Both will kill you slowly, from the inside, in ways you could never imagine.

Even if you’re not in a relationship, dating is like atherosclerosis too.

Before any open declaration of love is made, people often wonder if their affections are in fact being returned by the said object(s) of their affection. But that’s irrelevant.

It’s simply not the question you should be asking. Realise he/she/it probably does like you and just isn’t showing it. In which case, unless you’re willing to be the one to initiate things, thinking about it is futile.

So quit worrying. What matters is whether he/she/it likes you enough to act on it.

It’s an awful lot like atherosclerosis, which is inevitable, ongoing and present in all of us. But it’s hidden by default and doesn’t cause distress on a daily basis. What matters is whether you have physical signs of the disease.

Comfortingly for who those seek action, limiting your trans fat consumption and undertaking regular exercise may help with both dating and atherosclerosis.

Great advice? Yeah, you’re welcome.

Love doctor, out.