The Sad Evils Of Smoked Salmon

Smoked seafood has, unfortunately, been cast into the same category as preserved meats. These traitors have been linked with an increased risk of malignancy. Shun them all!

On the plus side, chicken is still in season(ing). As long as you’re not a greedy pig about it. Moderation, which basically means not over-gorging, is the key to success. That is, health.

References

  1. Egan, S. (2019). Do Lox and Other Smoked Fish Increase Cancer Risk?. Retrieved 29 August 2019, from https://www.nytimes.com/2019/07/26/well/eat/does-lox-and-other-smoked-fish-increase-cancer-risk.html
  2. Meat, Poultry, and Fish: Picking Healthy Proteins. (2017). Retrieved 29 August 2019, from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/meat-poultry-and-fish-picking-healthy-proteins

Cardiac Valves

Which side of the heart does each atrioventricular valve correspond to? Memory aids enlighten us all!

Atrioventricular Valves

  • Tricuspid is in the right heart
  • Mitral is in the left heart

What about the semilunar valves? They must not be forgotten! And so they shan’t be!

Semilunar Valves

  • Pulmonary goes to the lungs and is on the right
  • Aortical goes to the rest of the body and is on the left

Hypokalaemia ECG Changes

There are three major ones, plus more!

  1. ST depression
  2. Flattened T waves
  3. Abnormally prominent U waves

The way to remember this is that, in line with the subpar nature of hypokalaemia, everything is weak and low!

ST depression is a depression, so it is low.

The T waves have low amplitude, so they too are low.

The dip of the letter U, as in U waves, looks like the minimum point of a parabola, so it’s also low.

Conveniently, it all follows an alphabetical pattern: ST, T, U.

References

  1. ECG Learning Center. (n.d.). 12. Nice Seeing “U” Again. [online] Available at: https://ecg.utah.edu/lesson/12 [Accessed 4 Jul. 2018].
  2. Burns, E. (n.d.). Hypokalaemia. [online] LITFL. Available at: https://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/ [Accessed 4 Jul. 2018].

Podcast 015: Cardiology With Dr Chris Semsarian

Without the heart, there is no mindless muscle bag to pump blood all around the body. That would, unfortunately, lead to death.

Fortunately, cardiology exists to cure, palliate and address issues of this important organ!

In this episode, Professor Chris talks about his work as a specialist cardiologist, why he campaigned for public defibrillators and the crucial contribution of being passionate about your work.

Podcast

About the guest speaker

Dr Chris Semsarian is a cardiologist and professor with a specific research focus in the genetic basis of cardiovascular disease. He trained at the University of Sydney, Royal Prince Alfred Hospital and Harvard Medical School.

Professor Chris was awarded a Member in the General Division of the Order of Australia (AM) on January 26, 2017 for significant service to medicine in the field of cardiology as a clinician, administrator and educator and to the community. He has a large number of other letters behind his name too: MBBS PhD MPH FAHMS FRACP FRCPA FCSANZ FAHA FHRS.

Professor Chris has published over 200 peer-reviewed scientific publications, in the highest-ranking cardiovascular and general medical journals. A focus area of his research is in the investigation and prevention of sudden cardiac death in the young, particularly amongst children and young adults. He has been the primary supervisor of over 30 PhD, honours and medical honours students since 2003 and led major community programs in the area of prevention of sudden death.

Music credits

Opening and closing themes by Lily Chen.

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].

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].