Propofol-Induced Myocardial Depression: Does This Really Exist?

In the intensive care setting, propofol is a commonly used medication for management of sedation in mechanically ventilated, critically ill patients. However, intensivists often select dexmedetomidine over propofol in patients with cardiovascular disease due to concern for cardiac adverse effects such as myocardial depression. In this blog, I’ll be discussing three important considerations before accepting propofol-induced myocardial depression as clinically significant.

The Short End of the Stick: Practical Management of Cardiovascular Drug Shortages

Since 2010, the revolving door of unavailable drugs has forced healthcare workers to do (and spend) more with less. As such, pharmacists are being called upon to come up with creative and savvy solutions to combat the drug shortage crisis, all while ensuring patient care is not compromised. Few areas of acute care practice remain unaffected, including the cardiac care unit. In this bog, Dr Noel highlights recent, current, or probable drug shortages that have direct impact on cardiovascular care, and provides alternative medication options and clinical caveats for consideration.

Aspirin for Primary Prevention: Have We ARRIVEd at an Answer?

Evidence from multiple recent trials has brought to question the role of aspirin for primary prevention of cardiovascular disease. This remains common practice in the United States, despite questionable data to identify a population for whom the benefits outweigh the risks. In this blog, I compare recent evidence to current guideline recommendations and speculate whether or not aspirin will have a role for this indication in the future.

Getting to the Heart of the Patient Interview: A Focus on Heart Failure (Part II)

A thorough and accurate patient assessment is critical to managing patients with heart failure. In this second post of our two-part series, we’ll focus on volume status and adherence to medications and dietary recommendations. Check out our first post for general principles and an assessment of functional status. A template collection tool is also provided.

Getting to the Heart of the Patient Interview: A Focus on Heart Failure (Part I)

A thorough and accurate patient assessment is critical to managing patients with heart failure. In this two-part series, we’ll provide an overview of the key components of assessing patients with heart failure, starting first with general principles and an evaluation of functional status. Our second piece will focus on volume status and adherence to medications and dietary recommendations. A template collection tool is also provided.

Titration of Renin-Angiotensin System Inhibitors in Patients with Heart Failure with Reduced Ejection Fraction and an “At-Goal” Blood Pressure

Initiation and titration of guideline-directed medical therapy is paramount for patients with heart failure with reduced ejection fraction (HFrEF), as it reduces the risk of death and other complications. Despite this, many patients do not receive the appropriate therapies or doses due to concerns and/or misconceptions about the use of these therapies. One reason often cited for not using or titrating inhibitors of the renin-angiotensin system is that blood pressure is already “at goal” or is “too low”. In this blog, the data surrounding titration of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and the angiotensin II receptor blocker/neprilysin inhibitor in patients with HFrEF will be addressed.