Category: Medicine

Journal Club Presentations

Over the past two years, I have had numerous requests for copies of the slides I prepared for my LGH Cardiology Journal Club presentations. Since I am supposed to present every other week, this has led to 53 (and counting) presentations so far. COVID-19 temporarily halted journal club due to restrictions on gathering, and a number of the cardiology consultants were not keen on attending it over Zoom or Teams.

However, journal club has since restarted (2 months ago), so this number will increase.

I have uploaded all my presentations to date, (except two, which were too big to upload due to the embedded videos) to this site. You can find the link to the download page over on the sidebar (or at the bottom of the page, for those of you on mobile) entitled Journal Club Presentations. For obvious reasons, the full papers themselves are not available on this site.

Note: all copyrights are owned by their respective owners. Please contact me directly should there be any concerns.

A Delayed Case of “Suicide Ventricle” Post-TAVI Saved by Magnets and Alcohol

ANZET 2017 Certificate

I was selected as a finalist of the Geoff Mews Memorial ANZET Fellows’ Prize 2017 this year for my submission of an abstract with the title of “A Delayed Case of “Suicide Ventricle” Post-TAVI Saved by Magnets and Alcohol.

I presented the case at the ANZET Meeting 2017, but unfortunately did not win the prize.

Below is the abstract that I submitted.

A Delayed Case of “Suicide Ventricle” Post-TAVI Saved by Magnets and Alcohol

“Suicide ventricle” is a recognized phenomenon following Transcatheter Aortic Valve Implantation (TAVI) procedures. Here we present a delayed case of this phenomenon, saved by magnets and alcohol.

An 89 year old woman with severe aortic stenosis underwent TAVI. Her echocardiogram showed severe left ventricular hypertrophy, marked asymmetric septal hypertrophy, no dynamic left ventricular outflow tract (LVOT) gradient or systolic anterior motion (SAM) of the mitral leaflet. The procedure was uncomplicated with no evidence of SAM or LVOT obstruction peri-procedurally. Post-procedure, rapid AF developed. Her HR decreased to 50bpm with RV apical pacing. Echocardiogram showed no effusion, LVOT gradient or SAM. A septal permanent pacemaker was inserted due to persistent pacing dependence. Post-procedure her SBP dropped to 60mmHg and noradrenaline infusion was started. Her BP remained poor despite increasing doses and acute pulmonary oedema (APO) developed. Echocardiogram revealed a new LVOT gradient and SAM. Her HR was increased via magnet to the backup rate of 85bpm with immediate haemodynamic improvement. Noradrenaline was ceased. Alcohol septal ablation was considered and deferred due to improving haemodynamics. She remained well, but 5 days later developed APO. CPAP and frusemide were ineffective. Urgent alcohol septal ablation was performed with immediate improvement of her LVOT gradient. She was discharged 5 days later.

This case illustrates that a change in pacing location was sufficient to trigger LVOT obstruction with SAM and that a change in heart rate can result in a dramatic improvement in haemodynamics. Urgent alcohol septal ablation was life saving in this situation.

Homeopathy ‘treatments’ must be labelled to say they do not work, US government orders | The Independent

Homeopathy ‘treatments’ must be labelled to say they do not work, US government orders | The Independent:

“Now, the US government is requiring that producers of such items ensure that if they want to claim they are effective treatments, then they need to make available the proof. Otherwise, they will need to point out that there is “no scientific evidence that the product works”.”

“To believe homeopathy works … is to believe in magic.”

It’s about time they cracked down on those charlatans. It’s amazing how homeopaths have been allowed to lie to the public and peddle concoctions that have not an ounce of evidence behind their efficacy or safety without any oversight. More countries need to do this.

Yes, the article is from November last year, but I just came across it. It’s surprising it has not had more coverage. This is the press release from the FTC’s website.

Apps for New Docs

So a few weeks ago, the hashtag #TipsForNewDocs was trending on Twitter. A portion of those tips were recommending apps for new medical interns who were due to start their orientation and “Buddy Week” (in NSW). Next week, at the beginning of February, they’ll be starting work proper, at least in New South Wales.

A lot of the apps that were recommended then, were, in my opinion, irrelevant and totally useless for interns. No intern needs to know the National Institutes of Health Stroke Scale, as they will be calling their registrar for any and all strokes. Similarly, the Oxford Handbook of Anaesthesia, while useful for anaesthetists and anaesthetic/critical care registrars/SRMOS, would be overkill for the brand new intern.

Those apps are useful. Extremely useful. But not for an intern in their first term. They will trying to find their legs in the brave new world that they’ve entered. They have the stems of knowledge, but not the experience of how to use all that they have learned in university. As any doctor can tell you, it’s one thing to read about it, it’s a whole different ball game when it’s in front of you. They have the lives of people in their hands and they will be afraid of making a mistake that could end up severely injuring or killing a person. I know. I was an intern once.

The apps I recommended are, in my opinion, the most useful that any intern can have available at the beginning of their career. In fact, these apps would be useful for the rest of their careers too. They’re simple, but extremely useful apps. Of course, there may be someone out there scoffing at my choice of apps. I would be happy to hear their point of view.

The following apps are available on iOS, and may be available on other mobile operating systems too.

Continue reading “Apps for New Docs”