Does the thought of managing acute decompensated heart failure (ADHF) give you paroxysmal nocturnal dyspnea? Recline for a bit while Dr. Michelle Kittleson MD, PhD @MKittlesonMD (Cedars Sinai) takes us through the Zen of jugular venous pressure (JVP) exams, how to approach diuresis, and the fine points of hospital discharge. This knowledge food is easier to swallow than an oral potassium replacement.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!

Credits

• Written and Produced by: Deborah Gorth ScM
  
• Cover Art and Infographic by: Edison Jyang
  
• Hosts: Matthew Watto MD, FACP and Paul Williams MD, FACP
  
• Editor: Cyrus Askin MD (written materials); Clair Morgan of nodderly.com
  
• Guest: Michelle Kittleson MD, PhD
  

Sponsor - VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.

Time Stamps

• 00:00 Intro
  
• 02:40 Guest one-liner; Picks of the Week
  
• 08:33 Case from Kashlak part 1, Definition of acute decompensated heart failure (ADHF), Factors that lead to ADHF (FAILURE mnemonic)
  
• 13:39 Historical clues for ADHF; Is salt restriction needed? Fluid restriction?
  
• 20:42 More on History and Physical exam for ADHF; JVP exam in detail; Crackles are worthless?!
  
• 28:36 Labs to trend during an ADHF admission
  
• 33:15 Recap of history, physical exam, and initial approach; Initiating diuresis; Goal urine output; Diuresis in HFrEF vs HFpEF phenotypes
  
• 45:32 Diuretic resistance and when to use a drip, metolazone; Do K and Mg need to be 4 and 2?
  
• 49:05 When to hold guideline directed medical therapy (Beta blockers, ARNI, ACEI/ARB)
  
• 56:05 Who needs a right heart cath?
  
• 59:30 Endpoints for discharge; Switch to PO diuretics; Approach to discharge and transitions of care
  
• 64:04 SGLT2i in heart failure
• 68:15 Take home points and outro

Move smoothly through constipation evaluation and management. Learn how to evaluate for the various etiologies of constipation including pelvic floor dysfunction, IBS-C and more with our esteemed guest Dr. Xiao Jing (Iris) Wang @IrisWangMD! Claim free CME for this episode at curbsiders.vcuhealth.org!

Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits

• Producer, Show Notes, Infographic & Cover Art: Elena Gibson MD
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
• Reviewer: Emi Okamoto MD
• Executive Producer: Beth Garbitelli
• Showrunner: Matthew Watto MD, FACP
• Editor: Clair Morgan of nodderly.com
• Guest: Xiao Jing (Iris) Wang MD

Sponsor: ACP For the Early Bird discount, register before January 31. Use code IM22CURB. Visit annualmeeting.acponline.org to learn more. Register today to get the best pricing and bonus content. Sponsor: SquareSpace https://www.squarespace.com Sponsor: Masterworks Masterworks is giving listeners priority access to their newest offerings. Just head to masterworks.art/curbsiders CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Show Segments (Note: timestamps are without ads)

• Intro, disclaimer, guest bio
• Guest one-liner, Picks of the Week* (6:00)
• Case from Kashlak; Definitions (11:00)
• Physiology of a bowel movement (10:00)
• Definitions (16:00)
• Bowel Habit Review of Systems (17:00)
• Rectal Exam (33:00)
• Initial Constipation Evaluation
• Common categories of constipation (43:40)
• Additional evaluation of Constipation (52:00)
• Treatment options (1:10:00)
• Outro

When should you fold or Holt onto your cards for palpitations? Learn about properly characterizing a patient’s palpitations, red flag symptoms, when to grab an echocardiogram and/or heart monitoring, and when certain “benign” ECG findings can be concerning. We’re joined by the director of cardiac electrophysiology at Temple University Hospital, Dr. Joshua Cooper (@narrowQRS) for this episode chock full of cardiac pearls to make your heart skip a beat. Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits

• Producer, Show Notes, Infographic, and Cover Art: Edison Jyang
• Producer: Paul Williams MD, FACP
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
• Reviewer: Molly Heublein MD
• Executive Producer: Beth Garbitelli
• Showrunner: Matthew Watto MD, FACP
• Editor: Clair Morgan of nodderly.com
• Guest: Joshua Cooper MD

Sponsor: BetterHelp Special offer for The Curbsiders listeners: get 10% off your first month at betterhelp.com/Curb Sponsor: Panacea Financial Visit panaceafinancial.com today for information on their student loan refinance loans and to learn about their “refer a friend” program. Sponsor: Imperfect Foods Right now, Imperfect Foods is offering our listeners 20% off your first 4 orders when you go to https://www.imperfectfoods.com and use promo code CURB. Sponsor: Indeed Go to Indeed.com/INTERNALMEDICINE to claim your $75 CREDIT before March 31st. CME Partner: VCU Health CE
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner, Picks of the Week*
• Case from Kashlak
• Defining what the patient means by palpitations
• Common causes and misdiagnoses
• Red flag symptoms
• Exposures and medications to consider
• Sinus tachycardia
• Workup for palpitations
• Monitors
• Script for a negative workup
• Premature ventricular contractions
• Outro

Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow-up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”! Get the original show notes here!
Prior lipid episodes: #37 Lipids, PCSK9, and ezetimibe: Lower is better. #10 Cholesterol, lipids, statins, fish oil. Become a Master Lipidologist. Sorry, no CME for this reboot episode, but claim CME for past episodes at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!
Show Segments

• Intro
• Getting to know Dr. Erin Michos
• Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel
• Digging into ASCVD Risk Calculator
• Who should get 10 year ASCVD Risk assessment and what are the categories?
• How Dr. Michos discusses healthy lifestyle and “Primordial Prevention”
• What are “Risk Enhancing Factors”?
• Who should get biomarker testing vs CAC scoring?
• How Dr. Michos discusses statin therapy with her patients
• How to address risks of side effects
• Primary vs Secondary Prevention
• “What should my cholesterol be?”
• How often to follow-up labs?
• Differences between stain intensity
• How to manage side effects
• PCSK9 inhibitor discussion
• Aspirin, Fibrates and Icosapent Ethyl
• High Risk vs Stable ASCVD
• Take home points and the future
• Outro
  

Credits

• Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli MD
• Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA
• Infographic: Beth “Garbs” Garbitelli MD
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD...

We recap the top pearls from ACP #IM2022 including important drug interactions/intolerance (acetaminophen, tramadol, ticagrelor, nirmatrelvir-ritonavir), perioperative medicine (bridging, DOAC reversal agents, dental procedures, MINS), recognizing PMR, when to initiate urate-lowering therapy in gout, glucocorticoid-induced osteoporosis, food as medicine, dietary potassium, OSA, nocturia, telemedicine and health equity, a new obesity medicine paradigm, advances in HIV/PrEP, and rethinking atrial fibrillation! Note: Due to a rapid turnaround there is no CME for this episode, but visit curbsiders.vcuhealth.org to claim credit for past episodes.
Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Show Segments

• Intro
• Tapering long-term opioids
• Physician Wellbeing
• Common drug interactions (acetaminophen, ticagrelor, tramadol, Nirmatrelvir-ritonavir)
• Perioperative medicine (bridging, DOAC reversal agents, dental procedures, MINS)
• Nocturia and OSA
• Food as Medicine
• Rheumatology (how to diagnose PMR, when to initiate ULT for gout and steroid-induced osteoporosis)
• Avi’s pearls on (diversity, telemedicine, telehealth, burnout)
• Obesity medicine (a new paradigm and a new medication)
• HIV in primary care (PrEP, long-acting injectable antiviral therapy)
• Atrial fibrillation
• Outro

Credits

• Written, Produced, and Hosted by: Nora Taranto MD; Molly Heublein MD; Chris Chiu MD, FACP, FAAP; Avital O’Glasser MD, FACP; Alan Dow MD, FACP; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Show Notes: Matthew Watto MD, FACP
• Cover Art: Chris Chiu MD, FACP, FAAP
• Production team: Pod Paste

Sponsor: Indeed

Visit indeed.com/internalmedicine to claim you $75 credit now. Sponsor: Locumstory

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