In this interview, he discusses the importance of an integrated approach to understanding atrial fibrillation AFpersonalised medicine and the groundbreaking results of the CASTLE-AF trial. I was 11 years old. My grandmother said I should become a doctor, so I knew she was right. When you want to be a doctor from that age you plan for it—knowing you have to go to school and prepare for it every single day to eventually graduate into the field. So in every class I took, I was motivated by my dream to become a doctor.
At this point, I cannot imagine being anything else. Why did you choose to specialise in arrhythmias? I did my PhD work at the University of Heidelberg on cellular cardiology and electrophysiology, and there were a lot of unknowns back then. I loved the ion channels, all the changes and action potentials that define the propagation of the aorta, and how vulnerable they are. Particularly in cardiac electrophysiology, there were a lot of unanswered questions, and I just got hooked because it was so fascinating.
I knew then that it was an area of medicine that could grow to become very important, and I love tackling challenges and solving puzzles. Everybody was a mentor at that clinic. All these people had a role in shaping my life, pushing me in the right direction because they were all so driven and constantly striving to find the next big thing. What do you consider the most important development in the field during your career?
There have been two major breakthroughs. Number one is the birth of the AF ablation procedure, which happened early in the beginning of my career, and I was lucky to be there for that. AF ablation was not only an issue of treatment, but it also gave us access to the heart and helped us to better understand atrial fibrillation pathologically, and we are still learning from that.
Before, our understanding of AF was limited to viewing it from outside, so with the ablation procedure, we suddenly had that access to view the inter-cardiac behaviour of this disease. The second important development in AF is the improved understanding of structural changes in the atrium. Within the last 10 years, we have been able to image that structure and track it, and that is just as important or maybe more important than the AF itself.Kalimat opini adalah brainly
It is something that is becoming very important for understanding, monitoring and treating AF. The fact that we have found atrial fibrosis and atrial myopathy as independent risk factors for major cardiovascular events, strokes, mortality and hospitalisation.
That is a big deal in terms of the work of the last 10 years to define the myopathy as a major risk factor for strokes and AF, and it is the first major step to precision medicine and personalised treatment in my opinion.
Atrial fibrosis or myopathy, the foundation of AF has been a major focus in our research, from basic science to clinical studies. We are also developing novel magnetic resonance imaging MRI compatible ablation modalities, and working on tissue direct visualisation to better improve and personalise ablation outcomes. Finally, mobile health technology has been a major part of our work at CARMA for the last nine years.
We are trying to understand how to implant novel sensor technologies, biometric and electrocardiogram ECG devices into managing AF to help further personalise treatments. The rest of the work is done by engineers, basic scientists, outcome researchers, software engineers, physician assistants, medical students and so on.
I came to the University of Utah with the purpose of building the CARMA centre and bring all these subspecialties together to sit at the same table and tackle one issue, whether it is AF, ventricular arrhythmia, or something else.
We knew that the physician alone is not enough and we needed all these people who are equally hungry for research and elevation in their field. So we created the CARMA centre as a place to work together and optimise the collaboration of different types of expertise. How do you think this research will affect clinical decisions on AF ablation?
There are many studies showing that AF ablation improves outcomes, including ejection fraction, quality of life and AF recurrence, with subanalyses showing improved mortality as well. However, there had never been a single study conducted, finished and published to show that ablation in patients with AF can save lives and reduce hospitalisations.
Now we have to consider the fact that we can improve mortality and hospitalisation of patients, as well as the quality of life.Beyond the bone-grinding fatigue, she also could not catch her breath.
During a routine medical check-up a few months later, her doctor paused while listening to her heart. Martha did not realize it, but she was about to begin a long medical journey that would weave a genetic thread through space and time linking her to John Flemming Wakefield, her great, great, great, great grandfather who crossed the country as part of a caravan from Pennsylvania to Utah in the early th century.
After some additional medical tests, Martha was diagnosed with atrial fibrillation, a condition caused by an irregular heart rhythm that stresses the heart and increases the incidence of heart failure and stroke.
An electrocardiogram for a a normal patient and b a patient with atrial fibrillation. While atrial fibrillation is more common in older adults, it is highly unusual in a young person. At only 22 years old, Martha was an anomaly. During the next five years, she tried multiple medications to reign in her galloping heart.
While the medications brought her heartbeat under control, she also was burdened with debilitating side-effects from low blood pressure to uncontrolled blood sugar levels. And she was still so tired. With an eye toward personalized care, he used advanced heart imaging techniques developed at U of U Health to evaluate the severity of her condition and propose new options. He suggested that catheter ablation may be an effective treatment to restore her life to normal.
While it may seem like a scary, last resort, for Martha it was a lifesaver. During the procedure, the doctor burns the cells around the entrance of the pulmonary veins, creating scar tissue. Similar to firefighters laying down a suppression line to contain a forest fire, the scar tissue blocks the hyperactive rhythm from being transmitted to the rest of the heart, allowing the muscle to return to a regulated beat.
There were too many relatives suffering from atrial fibrillation, especially at a young age, to be a fluke. He put Martha in touch with geneticists at U of U Health to decipher this family mystery.
Several years later, Tristani-Firouzi and colleagues began identifying patients with early onset atrial fibrillation for a pilot project funded by the Utah Genome Project. Working with his colleagues in the Department of Human Genetics, they discovered a misspelling in the sequence. This small change in the code affected an ion channel on a gene called KCNQ1, which plays a crucial role in transmitting electrical signals in the heart.
According to Tristani-Firouzi, U of U Health researchers first linked the gene to Long QT syndrome, a condition associated with an erratic heartbeat, in the s. As a gain-of-function mutation, it set her heart into a hyperactive mode.
The upper chambers of the heart atria overperform compared to lower chambers ventriclesbeating beats per minute instead of the typical beats per minute. Tristani-Firouzi knew the Aston family could not be alone. He flagged clusters of distant relatives, all with early onset atrial fibrillation, who could trace their heritage to John Flemming Wakefield.
With a gene identified, Tristani-Firouzi is now taking the research to the laboratory. It is impossible to experiment on the human heart, but Tristani-Firouzi was not deterred.
He obtained blood cells from affected and unaffected patients and converted them into stem cells. Tristani-Firouzi is using these cells to understand the biology of the gene mutation.Thuyết tương đối hẹp của anhxtanh
The research team plans to study how the normal, healthy cells function compared to cells with the mutation. With this information, they can work to develop new treatments and therapies that could not only help Martha, her family, and her distant relatives, but other people who also suffer from similar heart conditions. For Martha and the Aston family, the most critical component of the story has already been written. Fifteen years after a diagnosis and 10 years after surgery, Martha is free of medication and living a normal life.For over 50 years the Division of Cardiovascular Medicine at the University of Utah has maintained a dedicated team of cardiologists, nurses and staff to provide high quality cardiovascular care to Utahns and residents throughout the Mountain West.
Our mission to serve our patients and their families is firmly linked to our chartered commitment to cutting-edge care of cardiac disease through discovery, research, and education, especially for the next generation of cardiovascular specialists. Read more. For many years Amyloidosis was considered a fatal disease.
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In the past few years several therapies have improved the survival and quality of life for people with Amyloidosis. Read More. As one young woman prepared to go on a mission for the Church of Jesus Christ of Latter-Day Saints she discovered a heart condition she was unaware of, a heart murmur.Mathbitsnotebook algebra 1 practice test
Thanks to the hard work done by the doctors at the University, this young women and many others are able to live full lives despite their heart murmur. Health care methods and practices are always evolving. These improvements usually come from failure and the reevaluation that follows such failures. He encourages people to trust the health care system by acknowledging the failures and understanding that those failures are being used to make improvements.
An exciting new paper on Cell Metabolism has recently been published by Dr. This paper discusses how the pyruvate-lactate axis modulates cardiac hypertrophy and heart failure. To view the paper, click here Misinformation comes in all shapes and sizes. It can be particularly challenging to tell fact from fiction when it comes to medical misinformation.
Dr. Nassir Marrouche, MD
John Ryan, MD, Assistant Professor in the Division of Cardiovascular Medicine at the U of U Health, highlights the challenges that come when patients hold medical beliefs based in misinformation and discusses the best approach to helping patients correct misinformation.
The University of Utah Cardiac Transplant Program has performed over 1, heart transplants over the last 35 years. Some of the recipients of these transplants talked about how their lives were changed by the treatment they received at the University of Utah and express their gratitude for the excellent care they experienced.
South Asian Americans have a higher risk of heart disease or cardiovascular complications. Although many different studies are being conducted to find an answer for this issue, there is still no know cause for this issue.University of Utah School of Medicine.
Marrouche has more experience with Electrophysiology, Adult Congenital Cardiac Disorders, and Cardiac Care than other specialists in his area.
He is accepting new patients. Be sure to call ahead with Dr. Marrouche to book an appointment. Based on treatment records, we have identified the following as areas of care that Dr. Marrouche treats more often than their peers. If you are unsure whether Dr. Marrouche treats other conditions, please contact the office at Electrophysiologists monitor, diagnose and treat abnormal heart rhythms through procedures such as electrocardiograms EKGs and pacemaker insertions Compare with other Electrophysiology specialists.
Adult congenital cardiac disorder specialists diagnose and treat heart disorders, such as arrythmias and mitral valve disease, that have been present from birth to adulthood. Compare with other Adult Congenital Cardiac Disorders specialists. Cardiac care specialists diagnose and treat general cardiac conditions such as high blood pressure, angina, and arrhythmias through procedures including cardiovascular stress tests, ablation therapy, and heart valve surgery.
Compare with other Cardiac Care specialists. Accepted insurance can change. Please double-check when making an appointment. Likelihood of recommending Dr. Marrouche to family and friends is 4. Is Dr. Nassir Marrouche, MD accepting new patients?
Nassir Marrouche, MD generally accepts new patients on Healthgrades. You can see Dr. Marrouche's profile to make an appointment. Use the Healthgrades insurance check to verify if Dr. Marrouche accepts your insurance. What are Dr. Nassir Marrouche, MD's top areas of care? See all practice areas where Dr. Marrouche specializes.Qashqai otomatik vites nasıl
Where is Dr. Nassir Marrouche, MD's office located? Find other locations and directions on Healthgrades. Does Dr.
Nassir Marrouche, MD offer telehealth services?His research interests include atrial fibrillation in patients with coexisting heart failure and equitable access to wearable cardiac technology for people of lower socioeconomic status.
Telemedicine and remote patient monitoring hold vast potential for the future of cardiology, but not everyone has access to them in equal measure. And because ambulatory monitoring can have a significant positive impact on how well one manages their health, we can say that this expanding mode of delivering care has deepened the divide between the two classes of medicine we are experiencing in the U.
It is important to keep this issue front and centre when we talk about what is probably the only positive effect of the Covid pandemic, which is having accelerated the digital transformation of medicine.
But it has also underscored the socioeconomic barriers that many of our patients face. At Tulane University we recently started a number of partnerships with major players in medical, tech and consumer fields to explore ways to extend the reach of cardiac RPM devices to people who would benefit from them.
It should target everybody, not just digitally savvy people who can afford smartwatches and fitness trackers. As far as the technology that makes remote patient monitoring possible is concerned, it hinges on one word: wearable. Wearable this, wearable that… the word is so overused that it has nearly lost its meaning.
There are wearable consumer devices that are of real value to physicians, but there are also others that are so inaccurate that they are practically worthless from a clinical standpoint. So what is a wearable? What should we expect from a wearable? With the market for such devices becoming ever more crowded, we need a way to differentiate between them and be able to recommend to our patients which one is right for them.
In the next two or three months, we are going to publish a peer-reviewed guidance paper that looks at some of these questions and proposes a set of guidelines. Once we have clarity on what types of cardiac wearables are useful for which patients, it is up to the developer community to make sure the underlying algorithms that power the interpretation of the data work for everyone, regardless of their ethnicity, age, or the region they live in.
Recently we have learned that the majority of medical AI tools in the U. And this has vast implications for how RPM tools learn and interpret data related to various health conditions and in different demographic settings. For me and my colleagues in cardiac electrophysiology, the most relevant question is: Can I read your heart story through a wearable device?
To answer that question, we need to know if the device and its machine learning algorithm can reliably label data that indicate severe, moderate, and benign health states. Colleagues from my generation and I are lucky in that we have seen and perceived the transition phase in medicine from the analogue stethoscope model to the digital app-based remote monitoring model. Nowadays, new ideas and technologies make many things simple, but the understanding we have of how heart health and health in general reflect socioeconomic disparities can contribute greatly toward developing socially responsible medical technology.
Mobile cardiac telemetry is a great place to start. And this has vast implications for how RPM tools learn and interpret data related to various health conditions and in different demographic settings For me and my colleagues in cardiac electrophysiology, the most relevant question is: Can I read your heart story through a wearable device? Executive summary: heart disease and stroke statistics— update: a report from the American Heart Association.
Changes in cardiovascular health in the United States, — J Am Heart Assoc. DOI: Machine learning algorithms to automate morphological and functional assessments in 2D echocardiography. J Am Coll Cardiol.The hotel location was very central with excellent facilities. All in all both of us felt that we were well looked after and were very impressed with the quality of service.
We loved this tour. Felt like we had Iceland to ourselves at some points, so quite and beautiful. The landscape is breathtaking and Icelanders are so welcoming.
We were surprised by the inventive cuisine, some of the best meals of our lives. We loved the guidebook and our own private itinerary booklet which we will keep as a souvenir of this amazing holiday.
The cell phone was a nice touch.Montagna cafe blackwood sa
Everything was well organized and made our time here easy. We arrived home safely after a 2-week stay in Iceland. I was so happy to be able to chat with you before I left Iceland. Let me thank you again for making all these arrangements for us and for answering all my questions before and after I made my booking. Your quick response to my email during my planning stage for this vacation made me trust your service and go with Nordic Visitor.
This trip to Iceland is truly a memorable vacation to us. Although we had to skip some places you suggested due to the tight schedule, we enjoyed the trip very much and everything went so smoothly.
All people we met during our 2-week stay made me feel like being home in Iceland. I appreciate how well the government of Iceland, people working in the tourism industry and the local people welcome the visitors.
I can tell you this is not my last trip to Iceland. I will come again. I am sure more and more people will start to discover how beautiful your country is. If any of my friends are interested in visiting Iceland, I will definitely recommend you and Nordic Visitor to them I wish all the best. There where some complications due to the volcano and our itinerary changed, but we had no problems.
It was excellent having the cellphone and we felt comfortable knowing that if things needed to be changed, they would be. Thank you for making our honeymoon stress free.CBAC Seminar - Nassir F. Marrouche, M.D., F.H.R.S., Monday, November 16, 2015
We will use you again in the future. Everything was quiet perfect, the receptions on the hotels, the bedrooms, and the places you recommended to see.We will also link extensively to our SAT study guides throughout this post to give you more targeted advice by section. That means that the math section is now weighted more heavily on the SAT. It's now very important to get a strong math score to get a good overall composite score. Also, answers now have four choices instead of five.
If you want to read a complete breakdown of differences between the old and new SAT, check out our post on the subject. All questions on the redesigned SAT Reading section are based on passages with set topics. On the old SAT, the questions often came from these categories but the topics were not predetermined. There is also more emphasis on defining vocabulary in context, understanding and using evidence, making logical arguments, and using scientific reasoning on the new SAT.
The emphasis is now on defining vocabulary in context. Via College Board's Test Specifications for the Redesigned SAT. For the old SAT, knowing vocabulary was crucial to doing well. So in addition to studying vocabulary words, you should also practice doing advanced reading and test your ability to define tough words based on their context. Your first place to head for SAT Reading practice is the source: the College Board website. They've posted a number of free new SAT practice tests.
Start there to get a sense of what the new SAT Reading section is like. Still have old SAT prep books sitting around. You can use old SAT Critical Reading questions to practice, but focus on the passage-based questions and ignore the sentence-completion questions.
ACT Reading section questions will also be helpful, as they are all passage-based and contain vocabulary in context as well as logical progression questions. Another unlikely but helpful source is ACT Science questions. ACT Science also has you break down charts, graphs, and evidence.
If you can do well on ACT Science, you will be able to do well on the new SAT data reasoning questions. Check out some sample questions over the Law School Admissions Council website. Want a bit more structure for vocabulary in context. One of my favorite tools for learning vocabulary in context is a browser app called ProfessorWord. This article alone has about a dozen SAT vocabulary words, according to ProfessorWord. The writing section is quite different on the new SAT.
There is more emphasis on logic and expression of ideas, higher-level writing skills, and punctuation. This means that there are fewer grammar rules tested in isolation, which in turn means fewer "gotcha" questions on the new SAT Writing section.
However, being aware of writing style, construction, and organization is more important, since you will now be working with longer passages. Start your studying by learning English grammar rules by heart. Then give the SAT's official practice tests a try. In terms of additional practice questions, we recommend you use ACT English practice questions, as these are all passage-based, like the new SAT Writing questions are.
You can also use old SAT Writing multiple-choice questions to test your grammar rule knowledge, but remember to be ready for passages. Finally, the more you read and write, the better you will get at spotting writing organization and style naturally.
The essay score is now completely separate from the writing score. The essay is now 50 minutes long instead of 25. You have to analyze how an author builds an argument in a passage (the passage will be part of the prompt).
Division of Cardiovascular Medicine
So you have to read the passage and write about it analytically during that 50-minute period. As we've mentioned, you should check out College Board's new SAT practice tests first to see real examples of the new SAT essay.Postage meter date rules
But if you run through all of the practice tests and want more free resources, there is another great source of practice you can use.
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