I do have anecdotal evidence of acute MI in young patients taking Chantix. I believe the Govmnt of Denmark is looking into this, any scientific evidence?

TO F FERNANDEZ:

I searched the FDA website for Chantix/varenicline and here's the link to the search results page. 

http://google2.fda.gov/search?output=xml_no_dtd&lr=&proxystylesheet=FDA&client=FDA&site=FDA&getfields=*&q=chantix

Looks like a usable hyperlink to me so give it a shot.  If it doesn't get you there, go to the FDA homepage at

www.fda.gov

Hmm! Looks like a hyperlink again!

If drugs are of ongoing interest to you, save the home page to your browser favourites.

Gord

You mentioned "work stress" as a contributor to Tim Russert's plaque rupture and sudden death.

Given we are all under "work stress" on a daily basis do you think that his obesity was the overwhelming cause of his myocardial infarction, and perhaps too much attention is given to stress as a cause of myocardial infarction.

"Work stress" seems to be the excuse people use for the cause of myocardial infarction when other well documted risk factors seem to be predominant. I would appreciate your thoughts, thanks for your time.

Thanks for your question, Guy. I agree that stress, per se, is not the real issue, but rather how the stress is countered is key. In the case of Tim Russert, he did indeed gain considerable weight beyond his baseline over the past year or so according to colleagues. Perhaps that indicates the unfavorable adaptation to his demanding work. But, importantly, there has to be more to it than that....which is why I suspect he had genomic underpinnings for plaque rupture.  With all the diabesity and stress out there, acute MIs are relatively rare and genomic susceptibility factors may ultimately explain this phenomenon.

From an Emergency Medicine perspective....

Apparently an AED on-site, but paramedics arrived before it was used - why the delay in AED use?

Bystander was attempting ventilation, but NO chest compressions being performed - obviously AHA scientific advisory on the importance of chest compressions has not been disseminated enough.

Sounds like he received only 3 defibrillations and ~15 minutes of on-scene treatment before transport to the hospital. Not very aggressive EMS care for a witnessed cardiac arrest (unless he had ROSC that hasn't been reported). AHA recommends pt NOT be moved while CPR in progress.

Very sad........................

Agree, Diane. When I first put up the post, there was no info on the AED but it was suspect. Now that we know there was a marked delay in its use, it is quite sad. One of the many vital lessons to learn from this catastrophe.

 I viewed your comments on the cease and desist order by California on genomic providers. Has the world not figured out that most if not all serious side effects of FDA approved drugs are genetically determined?  How will we ever learn who may safely use effective drugs if the means to determine their safety is barred by well meaning individuals who want to prevent charlatans from grabbing our money?  If I want to smoke cigarettes without the fear of contracting lung cancer - should I not be allowed to get the genetic test to show if that is the case?  The medical community rightly should prevent dangerous practices from continuing. Many may think that genomics is a waste of money and not effective or even provide mis-information but that is little reason to prevent those who think otherwise to continue to provide this service.  If we tried to eliminate all the  medical practices that have not been proven to be effective - we would have very little left. Thanks for your commentary - I agree.

The late Tim Russert,suffered Sudden Cardiac Arrest and Death,in mid June. Since then a plethora of literature and advices keeps pouring in.Some are suggestions,some are accusations(Not ethical).We all refuse to admitt that we know very little about prevention of S.C.D.The bad part is that we refuse to admitt our lack of knowledge.Before the defibrillators there was 5% survival from S.C.D.After the arrival of S.C.D. not much difference.Could it be,that we are doing wrong?.I believe we are.More so,we do not realize our mistake.How long has it been? 107 years!.You can read about it.

I have noted many patients coming in spooked by this person's death.  Bill Clinton was nearby a physician while in the Oval Office for 8 years, but we didn't get to him until he needed bypass surgery.  No accusations of individuals caring for him or for Tim Russert, but it does remind me that heart and vascular disease is still the leading cause of death in this country, that many still die of SCD before getting to the hospital, and there is some factor that is either randomness or something we are not measuring that explains your statement, Eric, that "With all the diabesity and stress out there, acute MIs are relatively rare..."

It also impresses me that even with appropriate treatment, the majority of people that would have had events still have them -- that is, if you have a treatment that lowers the MI rate 30-40%, that means that 60% will still have the event despite treatment!   Looking at it the other way, for primary prevention, treating someone with hypercholesterolemia changes their chance of NOT having an MI from 96% (estimate) to somewhere in the 97.5% range in the few year study period--  makes all of our efforts seem less impressive...

Don't worry -  I'm still advocating treating to ACC/NCEP/AHA goals, but I explain these realities to my patients.

 

 

Is the slowness of AED brandishment a failing or is it an indication that the whole concept of AEDs is so flawed as to be worthy of abandonment. Mr. Russert's case aside, isn't the real promise of defibrillation outside the bounds of the hospital in the provision of ICDs for "second-timers",  not AEDs for everyone, when most AEDs are thrown in the closet with the Christmas decorations.

Yet cardiologists have been coaxed by health insurers to ration ICDs as if they were actual human organs instead of the life-saving machines they will someday likely come into use by the majority of those who have survived their first SCA and would very much like the idea of being equipped to save the next one.