Statins in the elderly
!* ​Reverse gradients are found in the oldest old...high cholesterol may not always increase risk! What does this mean for statin use?
Triglyceride Disorders
*Big beach balls bouncing on the water probably won't hurt you. Look for TG and TC in 1:1 molar ratio.
HDL
**The reverse cholesterol transport story, but more than just cholesterol.
Right Ventricle
*
The RV is important; it isn't designed for high pressure. It can be a tight squeeze within the pericardium.
Long QT Interval
**Ion channels move sodium, potassium and calcium in and out. Not all cells have the same action potential duration.
Mitral Incompetence
*
If there's a large regurgitant volume, the LV enlarges. Lower the fluid level if the pot is splashing.
Acute Coronary Syndromes
*How the coronary artery occludes, plaque rupture and intraplaque haemorrhage. Forget about troponin!
Vasodepressor Syncope
*
Blood pools in the capacitance vessels. Let your friends know when you are about to shower upstairs!
Troponins
*The test that redirects most pathways. Does your kid brother rev his car engine?
Non-STEMI
**
!
What is Non-STEMI? Important alternatives to consider. Stay alive with coronary collaterals.
Warfarin in Asymptomatic AF
**Stroke risk may not be high enough to justify Warfarin. The number needed to harm. !
Biventricular Pacing*
Left bundle branch block for soccer fans.
Severe Aortic Stenosis
*** How to tell when aortic valve stenosis is severe.
Aortic Incompetence
* By the time there are symptoms, the LV may not recover. Like grandpa's pyjama pants.
95% Stenosis in Stable Angina
* !Not all blocked vessels lead to infarction. The importance of collaterals.
Alternative Dietary Guidelines
** ! A statement (or rant) about food.
LDL Receptor
**
A Venus fly-trap mechanism of LDL uptake; the special status of Familial Hypercholesterolaemia.
Re-Entry
*
Cardiac currents do donuts too! An introduction to laddergrams.
Pleiotropic Effects
!**
Statins and the HMGCoA reductase pathway, beyond cholesterol. Maybe you missed chemistry at high school.
Antiplatelet Drugs
**
The cycloxygenase pathway, the receptor for ADP, fibrinogen binding to the IIb,IIIa receptor. Where does your drug act?
Diastole
**
Diastole takes energy. The importance of ischaemia. Dysfunction is like a stiff back.
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Lipoprotein (a)
**
Maybe the link between lipoproteins and thrombosis, Lp(a) is one of the strongest genetic loci for coronary disease. What is a kringle?
Mitral Apparatus
**
More about the mitral valve. The chords and papillary muscles assist left ventricular systole.
Normal Coronary Flow
*
How the coronary circulation increases flow to regional beds. The nitric (not nitrous) oxide story.
Supply / Demand Imbalance
*
Living on a coronary blood flow budget. The pressure-volume loop.
Preload, Afterload & Contractility
**
How the left ventricle performs in systole, or how the donkey gets it's load up the hill.
Coronary Perfusion Pressure**
The heart is like a sponge; coronary perfusion pressure falls when LV diastolic pressure rises.
Left Ventricular Hypertrophy
*
How both concentric and eccentric LVH develop to normalise wall stress
Ejection Fraction & Endsystolic Volume
*
More about the LV in systole, EF is an old measure to correct for errors in estimating absolute LV volume. It can be misleading.
Non-Inferiority Trial Design
***Two wrongs don't make a right, but three rights do make a left. The desiderata of trial conduct may work against you...
Generalisability of Trial Results
*Who do trial results apply to? Why or why not? You decide.
Ribbons and Dresses
*!A political statement dressed as medical education. Who sets the agenda?
P Value and the Null Hypothesis*
Do you know? Most people don't. The simplest view of nature. Thanks to Olli Miettinen.
Statistical Verdicts
***
A must-read for jurisprudents. Acknowledging your prior beliefs. Thanks to Olli Miettinen & George Diamond.
Major Adverse Cardiac Events
*!!What's so major about outcomes in cardiovascular trials? Can we be sure of these?
Absolute & Relative Risk
*There is a difference, but how big is the effect? The importance of background risk. The Number Needed to Treat is the inverse of the absolute risk reduction
How to Read Survival Curves
**Watch out for cut-off y axes and other makeup techniques. Read survival curves at the median to get an 'average' outcome
Absolute & Relative Time
**Watch this in tandem with 'Absolute & relative risk' and 'Looking at survival curves'. Pink Floyd add the dimension of time to bring it all together