In this cross sectional study of 104 healthy volunteers, 71% had evidence of right to left shunting on saline contrast echo. The presence of right to left shunting is extremely common (from PFO’s and pulmonary AV malformations), and is likely not causally related to conditions such as migraines or crytogenic stroke (abstract)

In the previously published RE-LY trial, dabigatran was non-inferior to warfarin in stroke prevention in patients with afib. In this pre-specified sub-group analysis, dabigatran performed better (for preventing vascular events and mortality) than warfarin at sites with poor warfarin control (i.e. higher time to therapeutic INR). Dabigatran may be better than “non-inferior” to warfarin in “real life”, where INR control is worse than in clinical trials (abstract)

In this randomized trial of out of hospital cardiac arrest patients, those who were randomized to chest compressions with rescue breathing fared just as well as those without rescue breathing. Survival to hospital discharge and favorable neurologic outcome were not significantly different between the groups. Chest compressions without rescue breathing is as effective as chest compressions alone in cardiac arrest (abstract)

In this large cohort of 660 patients presenting with new onset fib/flutter, patients were managed with the Ottowa Aggressive Protocol, which utilized IV procainamide, then electrical cardioversion if necessary, then discharge home. In this cohort, 97% of patients were discharged home from the ED (93% of which were in sinus rhythm). The median length of stay in the ED was 5 hours, and the 7 day relapse rate was 9%. This protocol appears to be safe and effective in obviating the need for admission of most patients with new onset afib/flutter (abstract)

The duration of treatment for endocarditis caused by coxiella burnetti should be 18 months (or 24 for prosthetic valves) based on a recently published large 20-year cohort. Treatment with doxycycline and hydroxychloroquine are recommended (abstract) with 5 years of follow up to assess for relapse.

In the large retrospective cohort of patients with no known history of CAD, who were admitted to an ED-based chest pain unit, myocardial ischemia was found on stress testing in 14% of those with “typical” chest pain, 11% of those with “atypical” chest pain, and 16% of those with no chest pain (typical chest pain was substernal, exacerbated by exertion or stress, and relieved by rest or NTG). Presence or quality of chest pain symptoms unfortunately do not reliably predict myocardial ischemia (abstract)

In this prospective cohort 1005 patients scheduled for elective vascular surgery, all had an echo performed. Of all the patients, 21% had asymptomatic diastolic dysfunction, and 19% had asymptomatic systolic dysfunction. After multivariate adjustment, LV dysfunction independently predicted risk of 30 day cardiovascular events (OR 2.3 and 1.8 for systolic and diastolic dysfunction, respectively) and long term cardiovascular mortality (HR 4.6 and 3.0 for systolic and diastolic dysfunction, respectively) in patients undergoing open vascular surgery. Although the authors recommend routine pre-operative echo for patients undergoing vascular surgery, as of now it is unclear what interventions would be performed to reduce the risk of events (abstract)

Beta blockers have long thought to be contraindicated in patients with cocaine-associated chest pain. In this retrospective single center analysis of 331 patients with chest pain and cocaine-positive drug screens, almost half received a beta blocker. There was no significant differences in EKG changes or troponin levels between those that did and did not receive a beta blocker, but those discharged on a beta blocker had significantly lower long term cardiovascular mortality. Use of beta blockers appears to be safe in patients with cocaine-associated chest pain, and may actually improve long term mortality (abstract)

In this large community-based cohort, the incidence and mortality rates associated with acute MI decreased from 1999 to 2008. Compared to 1999, the adjusted odds ratio of 30 day MI-related death in 2008 was 0.76 (CI 0.65-0.89). The reduction in incidence is likely due to improved preventive measures and the reduction in morality due to improve short-term quality of care (abstract).

In this large retrospective observational cohort of CHF medicare patients, from 1993 to 2006, there were substantial decreases in mean LOS (from 8.8 to 6.3 day) and in-hospital mortality (9% to 4%). However, there were substantial increases in the percentage of patients discharged to skilled nursing facilities (13% to 20%) and the percentage of patients readmitted within 30 days (17% to 20%). These increases are likely reflecting CHF patients living longer and living sicker. However, new Medicare incentives to reduce readmission rates may push the pendulum back to longer LOS (abstract).