In patients with heart failure with low ejection fraction and chronic coronary disease without unstable symptoms, does stenting open blocked coronary arteries extend life or reduce hospitalizations? There is some literature to suggest those with low EF may benefit from revascularization with surgery.

How does the REVIVED trial change how we think about these patients? Tune in to the first episode in this new series brought to you by Core IM in collaboration with NEJM Group.

Show notes & Transcript

Access to Rotation Prep Cardiology guide on NEJM Resident 360 is free for August 2023. View the relevant sections on ACS and CHF.

Timestamps

• 00:50 Question REVIVED addressed
• 01:44 Revascularication in HFrEF
• 06:32 Revascularization in stable CAD
• 10:02 REVIVED trial
• 12:20 Summary and takeaways

Tags: IMCore, CoreIM, cardiology, internal medicine podcast, hospitalist, stent, CABG, evidence-based medicine

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Laugh and be humbled along some of Dr. Maria Rosasco's most memorable July stories !

Listen to the original July Stories: https://bit.ly/3Y4n8jG

Behind The Scenes videos on YouTube

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Tags: medical humanities, internal medicine, residency, medical school, interprofessional education, rotation, imposter syndrome, feedback

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BONUS on Cosyntropin stimulation tests! What exactly is it? How do you interpret them? What is the difference between adrenal insufficiency and steroid withdrawal syndrome?

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 

Behind The Scenes video on YouTube

Show notes & Transcript

Subscribe to our new Youtube Channel !

Tags: IMCore, CoreIM, endocrine, internal medicine podcast, hospitalist, glucocorticoid withdrawal, fatigue

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How do you choose between the different steroids? At what dose and duration do you get concerned about worrisome complications? What types of prophylaxis should be started in patients on steroids and when?In which patients should we wean steroids vs. stop abruptly, and how should we do so? What factors limit steroid weaning?

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Show notes & Transcript

Time Stamps

• 02:59 Types of Corticosteroids
• 14:31 Side Effects of Steroids
• 21:15: Prophylaxis 
• 27:32 Steroid Weaning 
• 33:38 Steroid Weaning Limitations 

Tags: IMCore, CoreIM, endocrine, adrenal insufficiency, internal medicine podcast, hospitalist, hydrocortisone, fludrocortisone, methylprednisolone, prednisone, dexamethasone, steroid withdrawal syndrome

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In cirrhosis, what actually contributes to the bleeding vs. clotting risk? Does the INR capture it? What is in FFP? Do you have to give FFP prior to a paracentesis and a thoracentesis? How much of FFP stays in the intravascular space? Does indwelling pleural catheters increase risk of malnutrition or infection?

Show notes & Transcript

Time Stamps

• 02:36 Deep Dive 1: Bleeding risk of paracentesis and thoracocentesis
• 05:35 Deep Dive 2: FFP effect on bleeding risk
• 15:43 Deep Dive 3: Risks of FFP
• 19:45 Deep Dive 4: Indwelling pleural catheters
• 30:31 Recap

Tags: IMCore, CoreIM, hepatology, internal medicine podcast, hospitalist, heme/onc, pulmonary

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How long can fatigue last for after radiation? Are all patient post radiation immunocompromised?  What are the potential acute and long-term side effects after lung, breast, prostate and brain radiation?

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Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

Time Stamps

• 02:37 Systemic Radiation Side Effects
• 14:29 Lung Radiation Side Effects
• 18:22 Breast Radiation Side Effects
• 21:45 Prostate Radiation Side Effects
• 24:54 Brain Radiation Side Effects

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, rad onc, EBRT, brachytherapy

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What are the different types of radiation? What should we and shouldn’t we put in our one-liners? What makes palliative radiation different from curative radiation? And when to refer to for palliative radiation?

Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

Time Stamps

• 02:04 What is radiation?
• 03:17 How does radiation therapy work?
• 04:50 How is today’s radiation different from the past?
• 05:40 What role does radiation play in cancer treatment?
• 07:48 What are the different types of radiation?
• 15:34 How do you write a rad onc one-liner as an internist?
• 19:59 What is palliative radiation and how/when should we use it?

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, EBRT, brachytherapy

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What did you have to "unlearn" in your learning journey? How do you organize your time? Organize how you keep up with medical evidence? What is your calendar management system? How can you use your leadership skills to improve the well-being of your team members?

Show notes & Transcript

Time Stamps

• 01:12 Learning Journey
• 05:58 Lifelong Learning
• 11:14 Time Management
• 16:38 Role Modeling
• 19:59 Re-Calibrating Failure

Tags: IMCore, CoreIM, failure, fixed mindset, growth mindset, imposter syndrome, leadership, learning styles, role modeling, success, time management

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What does the HbA1c really measure? What are its limitations? How does fructosamine and glycated albumin work? What will falsely elevate or decrease it? What are the benefits of continuous glucose monitoring? What are the limitations of a glucose-centric view and should we be more insulinocentric?

Show notes, Transcript and References

Time stamps

• 00:35 Random Glucose, Fasting Glucose, Glucose Tolerance Test
• 03:03 Hemoglobin A1c
• 08:26 Fructosamine and Glycated Albumin
• 10:50 Continuous Glucose Monitoring
• 15:44 The Overlooked Issue of Insulin Resistance
• 19:11 Summary

Tags: IM Core, CoreIM, insulin resistance, diabetes, microvascular and macrovascular complication

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When do you have a device interrogated? Do you know what kind of device your patient has? Do you know how to manage patients with a device who develop bacteremia? How do you discuss end of life care in patients with devices such as a pacemaker or ICD?

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• Show notes, Transcript and References

Time stamps

• 02:51 What are the different types of pacemakers and defibrillators? Who is it indicated for? How can where the leads clue you what the implantable device may do?
• 21:28 How to determine which type of device your patient has?
• 25:10 What can a device interrogation tell you and doesn't tell you?
• 32:13 Do all patients with bacteremia need their implantable cardiac devices taken out? 
• 38:44 End-of-life considerations with pacemakers vs. ICDs 

Tags: IM Core, CoreIM, sinus node dysfunction, AV dissociation, palliative care, CRT, biventricular pacing

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