Author Archives: Dr.Nabil Paktin

News and Views :Antibiotic Cotrimoxazole Combined With ACE Inhibitor or ARB Could Raise Risk of Sudden Death

October 31, 2014
TORONTO, ON — The risk of sudden death went up by more than a third in older patients taking ACE inhibitors or angiotensin-receptor blockers (ARBs) who were also put on the antibacterial agent cotrimoxazole, compared with those who were instead given amoxicillin, in a case-control study reported this week. The finding was independent of comorbidities, other medications, recent procedures, and other potential influencers of sudden-death risk, according to the authors.The elevated risk with cotrimoxazole, a combination of sulfamethoxazole and trimethoprim widely used for decades, was likely caused by its capacity for raising serum potassium, which became fatal on top of other medications known for causing hyperkalemia, speculate Dr Michael Fralick (University of Toronto, ON) and colleagues in their report, published October 30, 2014 in the BMJ. The same group had previously observed that combining cotrimoxazole with ACE inhibitors or ARBs similarly drove up the risk of hospitalization due to hyperkalemia.

“In patients who are on ACE inhibitors or ARBs, who are by definition at risk for hyperkalemia, the safest thing to do would be to use an antibiotic” other than cotrimoxazole, senior author Dr David N Juurlink (Institute for Clinical Evaluative Sciences and the University of Toronto, ON) told heartwire . “But that’s not always going to be practical. Alternate strategies could be to use a lower dose or a shorter duration of the drug. Or, when you have to give trimethoprim-based antibiotics to somebody who’s on an ACE inhibitor or an ARB, at a minimum being mindful of the potential for serious and even life-threatening hyperkalemia. That alone would go a long way toward reducing the dangers of this interaction.”

That goes especially for some susceptible patient groups. “Patients with type 2 diabetes are sitting ducks for this,” Juurlink said. “They have a tendency for hyperkalemia independent of anything else, because of what the diabetes does to their kidney function.” And patients with heart failure may be on potassium-sparing spironolactone as well as ACE inhibitors or ARBs. “Someone who has reduced left ventricular function and has diabetes—there are millions of people like that in North America.”

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Three Types of Atrial Remodeling secondary to Atrial Fibrillation (AF) ! Difference between adaptation and Remodeling in Atrial Fibrillation (AF) .

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WPW and Delta Wave

my WPW wave

NEWS AND VIEWS -Long-Term Outcome of PCI Versus CABG in Insulin and Non–Insulin-Treated Diabetic Patients -Results From the FREEDOM Trial

news and views - Cabg vs PCI

News and Views: Increased Mortality Associated With Digoxin in Contemporary Patients With Atrial Fibrillation Findings From the TREAT-AF Study

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News and Views ; Atrial fibrillation associated with ivabradine treatment: meta-analysis of randomised controlled trials

Objective :To quantify any risk of atrial fibrillation (AF) associated with ivabradine treatment by meta-analysis of clinical trial data.
Methods Medline, Embase, Web of Knowledge and the Cochrane central register of controlled trials were searched for double-blinded randomised controlled trials of ivabradine with a minimum follow-up period of 4 weeks. For studies where AF data were unpublished, safety data were obtained from the European Medicines
Agency (EMeA) website and personal communications. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. Metaanalyses were performed of relative risk of AF and absolute risk difference of AF per year of treatment. The main outcome measure was incident AF during the follow-up period.

Results: AF data were available from 11 studies: one from the published report, six from the EMeA and four from personal communications. Ivabradine treatment was associated with a relative risk of AF of 1.15 (95% CI
1.07 to 1.24, p=0.0027) among 21 571 patients in the meta-analysis. From this we estimated that the number needed to harm for ivabradine would be 208 (95% CI 122 to 667) per year of treatment.
AF is a substantially more common side effect of ivabradine treatment than one patient in 10 000, the risk presently reported in the product literature. The incidence of AF has not routinely been reported in clinical trials of ivabradine. Ivabradine treatment is associated with a 15% increase in the RR of AF. We estimate that 208 patient-years of treatment with ivabradine would be required to cause one new case of AF.

Martin RIR, et al. Heart 2014;100:1506–1510. doi:10.1136/heartjnl-2014-305482

Food to Drug Interaction! Warfarin-Food Interaction !

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New Algorithms on Tachycardia and Bradycardia

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Pathophysiology of intermittent claudication

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What is CVP ? Abnormalites of CVP , High Vs. Low and Unilateral Vs. Bilateral Concepts of CVP !

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