Internal Medicine Alert – November 15, 2024

Early Bird or Night Owl: Who’s Mentally Sharper?

A large cross-sectional analysis of adults aged 53-86 years found that people with normal sleep durations while being “night owls” often scored higher on cognitive tests than “early bird” types.

A New Drug for Heart Failure with Preserved Ejection Fraction?

The addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to standard therapy reduced the incidence of recurrent heart failure and death compared to placebo in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction and was generally well tolerated.

Screening for Atrial Fibrillation in Older Adults

A two-week ambulatory electrocardiogram monitor in a large group of individuals 70 years of age or older with no history of atrial fibrillation (AF) showed a very low incidence of AF (4.4%), almost all of which was paroxysmal. In less than 2% of the subjects did it represent ≥ 2% of the monitoring time. However, some patients had hours of AF, raising a concern for thromboembolic risk.

Antithrombotic Treatment for Atrial Fibrillation After Acute Coronary Events

An analysis of the AUGUSTUS trial comparing a P2Y12 inhibitor plus four combinations of double or triple therapy with apixaban, aspirin, and a vitamin K antagonist in patients with atrial fibrillation and a recent acute coronary event or percutaneous coronary intervention has shown that a P2Y12 inhibitor plus apixaban exhibited the lowest rate of major adverse events and major bleeding events.

A New Technique for Predicting Outcomes in Asymptomatic AS

An international study of patients with moderate or asymptomatic severe aortic stenosis has demonstrated that increased amounts of left ventricular fibrosis, as measured by cardiac magnetic resonance imaging, is associated with worse outcomes.

Xanomeline and Trospium Chloride Capsules (Cobenfy)

The U.S. Food and Drug Administration has approved the first-in-class muscarinic agonist and antagonists for the treatment of schizophrenia in adults. This is the first antipsychotic drug approved in decades and is unique in that it targets cholinergic receptors — unlike traditional agents, which target dopamine receptors.

How Does the 12-Lead Help?

You are given the electrocardiogram (ECG) in the figure without the benefit of any history. How would you interpret this tracing? How does the 12-lead ECG help with interpretation of the rhythm?