A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.
Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over 75).Enox...
Source: Dr. Smith's ECG Blog - November 8, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

60-something with 2 days of intermittent epigastric pain. Why does the cardiologist disagree?
One of our residents who just graduated 3 months ago texted me this ECG:" Hey Steve, would be grateful for any thoughts on this EKG.  60-something with 2 days of waxing and waning epigastric pain and diaphoresis.  Also diffuse abdominal tenderness. "Presenting ECG:What was my answer?What is the management? My Answer: " Inferior and lateral OMI "Detailed Interpretation:Sinus rhythm.  Left axis deviation, but not quite LAFB (no r-wave in inferior leads; no q-wave in aVL).  There is less than 1 mm STE in inferior leads, with reciprocal ST depression. There are hyperacute T-wav...
Source: Dr. Smith's ECG Blog - October 20, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

Cardiology MCQ Test 5
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Cardiology MCQ Test 2
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Antidote for dabigatran – Cardiology MCQ
Which of the following is an antidote for dabigatran? a) Abciximab b) Idarucizumab c) Infliximab d) None of the above Correct answer: b) Idarucizumab Abciximab is an antiplatelet agent (glycoprotein Iib/IIIa antagonist) and infliximab is a tumor necrosis factor alpha (TNF-α) antagonist used in the treatment of autoimmune disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - March 9, 2017 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance New Test Series 1
Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ...
Source: Cardiophile MD - June 28, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 25
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 25. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated...
Source: Cardiophile MD - April 4, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 21
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 21. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - March 8, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 14
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 14. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 7, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 4
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 4. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 18, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

PCSK9 inhibitor – Cardiology MCQ
The PCSK9 inhibitor which was recently approved by US FDA: a) Evolocumab b) Alirocumab c) Infliximab d) Abciximab Correct answer: b) Alirocumab Both evolocumab and alirocumab are PCSK9 inhibitors (proprotein convertase subtilisin/kexin type 9 inhibitors) [1]. PCSK9 inhibitors have been approved by US FDA (U.S. Food and Drug Administration) in those whom hypercholesterolemia is not controlled with diet and maximally tolerated statin treatment, if they have clinically manifest atherosclerotic disease like stroke or myocardial infarction [2]. Alirocumab can be given as a self administered subcutaneous inje...
Source: Cardiophile MD - July 31, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Alirocumab hypercholesterolemia proprotein convertase subtilisin/kexin type 9 inhibitors Source Type: blogs

Elimination of unfractionated heparin – Cardiology MCQ
Principal route of elimination of unfractionated heparin: a) Renal b) Hepatic c) Reticuloendothelial system d) None of the above Correct answer: c) Reticuloendothelial system Unfractionated heparin being a large molecule, is eliminated mainly by the reticuloendothelial system, like abciximab. Renal excretion plays only a minor role in the elimination of unfractionated heparin from the body and hence it can be used with better safety profile in the presence of renal dysfunction. In contrast, a significant amount of low molecular weight heparin (most commonly used being enoxaparin) is eliminated by renal excretion (about for...
Source: Cardiophile MD - May 31, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Glycoprotein IIb/IIIa receptor antagonist – Cardiology MCQ
Which of the following is not a glycoprotein IIb/IIIa receptor antagonist? a) Eptifibatide b) Tirofiban c) Abciximab d) Apixaban Correct answer: d) Apixaban Apixaban is an oral is a direct factor Xa inhibitor, while all the others are glycoprotein IIb/IIIa receptor antagonists, which are given parenterally. Apixaban is used for prophylaxis against deep vein thrombosis after orthopedic surgery and for other antithrombotic applications. Glycoprotein IIb/IIIa receptor antagonists are mostly used in the setting of percutaneous coronary interventions. Glycoprotein IIb/IIIa receptor is the final common pathway in platelet a...
Source: Cardiophile MD - May 28, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

PhRMA and DOJ Go Back and Forth Over Off-Label Speech and the First Amendment
A whistleblower’s False Claims Act (FCA) suit in the Eastern District of California has caught the attention of the Pharmaceutical Research and Manufacturers of America (PhRMA) and subsequently the Department of Justice, both of whom have filed amicus curiae briefs in the federal court. PhRMA re-responded to DOJ just last week, underscoring the case's importance. See that response here: PhRMA-Brief-Solis-v-Millennium.  Whistleblower Complaint Frank Solis, a former sales rep at Schering-Plough (now part of Merck) and Millennium Pharmaceuticals, alleged that the two manufacturers illegally marketed ...
Source: Policy and Medicine - September 17, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

9 Hours of Chest Pain and Deep Q-waves: Is it too late for Thrombolytics? (Time Window for Reperfusion; Acuteness on the ECG)
Conclusion: An invasive strategy based on coronary stenting with adjunctive use ofabciximab reduces infarct size in patients with acute STEMI without persistent symptomspresenting 12 to 48 hours after symptom onset.This is a section on "Acuteness" that I wrote in a Chapter on Reperfusion therapy that I wrote with Bill Brady in Critical Decisions in Emergency and Acute Care Electrocardiography.  I have updated it here.Here are a couple posts that demonstrate the issue of acuteness.Acuteness—when is it too late for reperfusion?  In deciding on reperfusion, particularly on fibrinolytic ther...
Source: Dr. Smith's ECG Blog - August 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG
A previously healthy woman about 50 years old with no previous medical history or coronary risk factors presented 30 minutes after the sudden onset of severe substernal chest pain.  An ECG was recorded and interpreted within 13 minutes:Sinus rhythm.  Intraventricular conduction delay with a QRS of 117 ms (really, incomplete LBBB)There are hyperacute T-waves in V4-V6, I and aVL, with reciprocal ST depression and T-wave in version in III and aVF.  V4 shows a de Winter's T-wave, with some ST depression.  This is diagnostic of proximal LAD occlusion, and I activated the cath lab the moment I saw this ECG.&n...
Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Clopidogrel
is a: a) P2Y12 receptor antagonist b) GP IIb/IIIa inhibitor c) Vitamin K antagonist d) None of the above Correct answer: a) P2Y12 receptor antagonist Clopidogrel, ticlopidine and prasugrel are P2Y12 receptor antagonists. GP IIb/IIIa inhibitors include abciximab, eptifibatide and tirofiban. Warfarin and acenocoumarol are vitamin K antagonists. (Source: Cardiophile MD)
Source: Cardiophile MD - November 3, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance P2Y12 receptor antagonist Source Type: blogs

Cardiology MCQ Test 5
Cardiology MCQ Online 5 Time limit: 0 Quiz-summary 0 of 25 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions b...
Source: Cardiophile MD - July 15, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ Online 5
Time limit: 0 Quiz-summary 0 of 25 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. We strongly advi...
Source: Cardiophile MD - July 15, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ Test 3
Cardiology MCQ Online 3 Time limit: 0 Quiz-summary 0 of 25 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions b...
Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ Online 3
Time limit: 0 Quiz-summary 0 of 25 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. We strongly advi...
Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ Test 2
Cardiology MCQ Online 2 Time limit: 0 Quiz-summary 0 of 15 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. We strongly advise you to verify the answers with standard text books. You have already co...
Source: Cardiophile MD - June 5, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ Source Type: blogs

Cardiology MCQ Online 2
Time limit: 0 Quiz-summary 0 of 15 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 You are welcome to try this Cardiology MCQ set and share it among your friends. We strongly advise you to verify the answers with standard text books. After completion of test, please send your score for display through the test system so that you can assess your performance compared to other users. You have ...
Source: Cardiophile MD - June 5, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ Source Type: blogs

Cardiology Online Test Series 1
Cardiology MCQ Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 You are welcome to try this Cardiology MCQ set and share it among your friends. We strongly advise you to verify the answers with standard ...
Source: Cardiophile MD - May 19, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs