Cardiology

Careful QTc monitoring with fluoroquinolone-azole combinations

This small retrospective single center cohort found that 22% of patients on combination fluoroquinolone-azole drugs had clinically significant prolongation of their QT interval. Careful monitoring should be done for patients on this combination of drugs (abstract).

Comparing rate controllers for Afib

This study evaluated the mean heart rate (by holter monitoring) of 60 patients with permanent Afib with 4 different medications: Diltiazem 360 mg/day, verapamil 240 mg/day, metoprolol 100 mg/day, or carvedilol 25 mg/day; each was given for 3 weeks in random order. The mean heart rate was 96 before treatment, 84 with carvedilol, 82 with metoprolol, 81 with  verapamil, and 75 with diltiazem. Diltiazem also significantly reduced the severity and frequency of symptoms and should be the drug of choice for Afib rate control unless contraindicated (abstract).

Restrict blood transfusions in AMI

This large systematic review of patients with AMI found blood transfusions were associated with higher risk of mortality and subsequent AMI compared to no transfusion, regardless of baseline, nadir, or change in hemoglobin. As with many other conditions, the use of blood transfusions should be minimized in patients with AMI (abstract).

Dabigatran not to used with mechanical valves

The FDA has issued a safety alert to avoid the use of dabigatran in patients with mechanical heart valves; a randomized trial was stopped early, as patients with mechanical heart valves were more likely to experience heart attack, stroke, or valve clot while on dabigatran compared to warfarin (FDA site).

2013 STEMI guidelines issued

The ACC/AHA have issued updated guidelines on the management of STEMI; some of the many recommendations include the need for reperfusion within 12 hours of symptoms, with a preference for PCI over thrombolytics (when available), lifelong use of ASA and ACE (in most patients) and need for smoking cessation. The full guidelines can be found at (ACC page)
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