NACCE – Net Adverse Clinical and Cerebral Events
NACCE – Net Adverse Clinical and Cerebral Events is a new metric being measured in all recent clinical trials in cardiovascular medicine. NACCE is a composite of  a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding [1]. NACE was another similar acronym introduced in the in the HORIZONS Trial [2]. NACE = net adverse clinical event(s) NACE = (MACE + major bleeding unrelated to coronary artery bypass grafting) MACE = major adverse cardiovascular event(s) Components of MACE are death, reinfarction, ischemia-driven target vessel revascularization, and stroke. Reference Feres F e...
Source: Cardiophile MD - November 11, 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

Cardiology MCQ Test
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 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 test. Start Congratulations - you have completed Cardiology MCQ Test. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% Your answers a...
Source: Cardiophile MD - October 16, 2017 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ Source Type: blogs

Anticoagulation for primary PCI – Cardiology MCQ
Which of the following should not be used as sole anticoagulant for primary percutaneous coronary angioplasty ?   a) Unfractionated heparin b) Bivalirudin c) Fondaparinux d) None of the above Correct answer: c) Fondaprinux   If Fondaparinux is used as the sole anticoagulant during primary PCI, there is a higher incidence of catheter thrombosis. Unfractionated heparin is used in most cases, supplemented if needed, by glycoprotein IIb/IIIa receptor antagonist if needed in case of significant thrombus load. Some prefer Bivalirudin in cases with a higher bleeding risk instead of the above combination. (Source: Cardiophile MD)
Source: Cardiophile MD - December 4, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology 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

Bivalirudin – Cardiology MCQ
Recommended test for monitoring the effect of bivalirudin during cardiopulmonary bypass: a) Activated clotting time (ACT) b) Ecarin clotting time (ECT) c) Prothrombin time (PT) d) Activated partial thromboplastin time (aPTT) Correct answer: b) Ecarin clotting time Reference: Salter BS et al. Heparin-Induced Thrombocytopenia – A Comprehensive Clinical Review. J Am Coll Cardiol. 2016;67(21):2519-2532. (Source: Cardiophile MD)
Source: Cardiophile MD - May 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 9
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 9. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 27, 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 8
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease. This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - January 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 7
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 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 23, 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

Cardiology MCQ: Catheter thrombosis with Fondaparinux
Catheter thrombosis with Fondaparinux is due to: a) High anti-Factor Xa activity b) Low anti-Factor IIa activity c) High factor VIIIa activity d) Low factor Xa activity Correct answer: b) Low anti-Factor IIa activity Though Fondaparinux is a safe and effective in the management of ST elevation myocardial infarction, it was associated with a higher incidence of guide catheter thrombosis in those who underwent percutaneous coronary intervention. The same concern applies to non ST elevation acute coronary syndromes where fondaparinux is ideal in terms of lower bleeding risk, albeit with a potential risk of guide catheter thro...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology MCQ Coronary Interventions DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ: Heparin induced thrombocytopenia syndrome – HIT / HITS
Wrong about heparin induced thrombocytopenia syndrome (HITS): a) HIT 1 is more dangerous than HIT 2 b) HIT 1 is non-immune mediated c) HIT 2 is associated with thrombosis d) HIT 2 is also known as HITTS (Heparin Induced Thrombocytopenia and Thrombosis Syndrome) Correct answer: a) HIT 1 is more dangerous than HIT 2 HIT 1 is self limited and unlikely to worsen with continued usage of Heparin. Heparin induced thrombocytopenia syndrome (HIT / HITS) is of two types – HIT I and HIT II (HIT 1 and 2). HIT 1 is a self limiting disease and a non-immune mediated response to heparin which occurs within 1 – 4 days of expos...
Source: Cardiophile MD - November 24, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ: Heparin induced thrombocytopenia syndrome (HIT)
Heparin induced thrombocytopenia (HIT) syndrome with thrombosis can be treated with: a) Unfractionated heparin b) Low molecular weight heparin c) Bivalirudin d) None of the above Correct answer: c) Bivalirudin Bivalirudin and Argatroban are two direct thrombin inhibitors which can be used in the treatment of Heparin induced thrombocytopenia (HIT) syndrome with thrombosis. Though low molecular weight heparins are less likely to cause heparin induced thrombocytopenia, once the syndrome is established, switching over to low molecular weight heparin from unfractionated heparin is not useful. The incidence of the syndrome has b...
Source: Cardiophile MD - November 24, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Argatroban Bivalirudin Heparin induced thrombocytopenia HIT Source Type: blogs

Research and Reviews in the Fastlane 057
This study compared bivalirudin to unfractionated heparin with the primary combined endpoint of death, CVA, reinfarction and target lesion revascularization. In spite of the fact that the trial was designed to favor bivalirudin (open-label), the authors found an increased rate in the primary outcome in the bivalirudin group (8.7% vs. 5.7%). Further proof that just because a drug is new, doesn’t mean it’s better. Recommended by: Anand Swaminathan Trauma, PediatricsAltgärde J, Redéen S, Hilding N, Drott P. Horse-related trauma in children and adults during a two year period. Scand J Trauma Resus...
Source: Life in the Fast Lane - November 10, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma Wilderness Medicine airway brain failure critical care General Surgery hypothermia Intensive Care prehospital recommendations Review Source Type: blogs

Cardiology MCQ 380: Bivalirudin
Bivalirudin a) Bivalirudin is a synthetic 20 amino acid polypeptide b) Inactivates both free and fibrin bound thrombin c) Useful in HITS d) All of the above ["Click here for the answer with explanation", "Correct Answer:"] d) All of the above Bivalirudin is a synthetic 20 amino acid polypeptide – interacts bivalently with both active catalytic site and exosite 1 of thrombin. Inactivates both free and fibrin bound thrombin Short half life of 25 minutes – confers a potential safety advantage Half life may be increased in renal failure Useful in HITS (Heparin Induced Thrombocytopenia Syn...
Source: Cardiophile MD - November 4, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote) Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884 The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves! Recommended by: Chris ...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs

Secrets Behind the Curtain
“Doc to the radio phone,” went the call over the PA. This is often just medics notifying about a diabetic refusing transport or stopping a futile code, though like most of emergency medicine, it can be anything. Then we heard, “STEMI. Activating prehospital.” EMS had been called to the house of a 54-year-old man. He had been experiencing chest pain on and off for several weeks. The most recent episode began about 30 minutes prior to ED arrival. He described 8/10 retrosternal pressure that radiated down his arms. He was tachypneic, but denied shortness of breath and was not hypoxic. Other vital signs...
Source: Spontaneous Circulation - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Top stories in health and medicine, August 15, 2014
From MedPage Today: NSAIDs May Slow Breast Ca in Obese Women. Obese women with estrogen receptor-positive breast cancer had a 52% lower risk of recurrence when they regularly used aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Mix of Kudos and Caution for Fecal DNA Test. Approval and imminent Medicare coverage of a DNA screening test for colorectal cancer generally received props from clinicians and researchers, who nonetheless cited continued patient aversion as the biggest obstacle to screening. Hospitals Seek To Help With ACA Premiums. Low-income consumers struggling to pay their premiums may soon...
Source: Kevin, M.D. - Medical Weblog - August 15, 2014 Category: Journals (General) Authors: Tags: News Cancer GI Source Type: blogs

FDA Places Clinical Hold On Phase 3 Trial Of Novel Anticoagulant
A highly promising novel anticoagulant system now appears to be in serious difficulty. Regado Biosciences announced today that the FDA had placed a “clinical hold” on patient enrollment and dosing in the REGULATE-PCI trial, which is testing the Revolixys anticoagulation system. Revolixys consists of the Factor IX inhibitor pegnivacogin and an agent, anivamersen, which reverses its anticoagulant effect. REGULATE-PCI is a phase 3 trial comparing Revolixys to bivalirudin (Angiomax, The Medicines Company) in 13,000 patients undergoing PCI. … Click here to read the...
Source: CardioBrief - July 10, 2014 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics anticoagulants FDA Regado Biosciences The Medicines Company Source Type: blogs

Controversial Trial Finds No Benefit For Expensive Medicines Company Drug
Although there is broad consensus in the medical community that primary PCI is the best treatment for heart attack patients when it can be delivered promptly, there is no agreement about the best accompanying drug regimen, which usually entails a combination of antiplatelet and antithrombotic drugs. The role of one antithrombotic, bivalirudin (Angiomax, The Medicines Company) has been particularly uncertain because it is far more expensive than its alternative, unfractionated heparin. HEAT-PPCI was designed to help settle this problem. … Click here to read the full post on Forbes.   (Source: CardioBrief)
Source: CardioBrief - July 7, 2014 Category: Cardiology Authors: Larry Husten Tags: MI/ACS People, Places & Events Policy & Ethics Angiomax Bivalirudin heparin Informed consent primary PCI Source Type: blogs

Study: Closure devices cut complications after cardiac procedure (VIDEO)
The use of vascular closure devices significantly reduced complications and the need for transfusions in obese and overweight patients undergoing transfemoral percutaneous coronary intervention (PCI), but the benefit over manual closure was not seen in lean and normal-weight patients or in those treated with a glycoprotein IIb/IIIa inhibitor, researchers reported.The benefit was also counterbalanced by a small increase in risk of retroperitoneal bleeding, Hitinder S. Gurm, MD, of the University of Michigan Cardiovascular Center in Ann Arbor, and colleagues, wrote online in the Annals of Internal Medicine.Vascular closure d...
Source: Medical Hemostat - November 21, 2013 Category: Technology Consultants Authors: hemostatguy at gmail.com (hemostat guy) Source Type: blogs

EUROMAX Meets Primary Endpoint But Editorialist Raises Questions
When started during transport to the hospital during a heart attack, bivalirudin (Angiox, Medicines Company) improves clinical outcomes and reduces major bleeding, though at the cost of a small but significant risk in stent thrombosis. The results of the European Ambulance Acute Coronary Syndrome (ACS) Angiography) Trial (EUROMAX) were presented today by Phillippe Gabriel Steg at the TCT conference in San Francisco and published simultaneously in the New England Journal of Medicine. … Click here to read the full post on Forbes.       (Source: CardioBrief)
Source: CardioBrief - October 30, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery MI/ACS angiography Angiox Bivalirudin EUROMAX myocardial infarction Source Type: blogs

Heparin induced thrombocytopenia syndrome (HIT)
Heparin induced thrombocytopenia (HIT) syndrome with thrombosis can be treated with: a) Unfractionated heparin b) Low molecular weight heparin c) Bivalirudin d) None of the above Correct answer: c) Bivalirudin Bivalirudin and Argatroban are two direct thrombin inhibitors which can be used in the treatment of Heparin induced thrombocytopenia (HIT) syndrome with thrombosis (Source: Cardiophile MD)
Source: Cardiophile MD - September 23, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Transcatheter Valve Therapeutics 2013 Meeting Kicks Off
This post was authored by Xiushui (Mike) Ren, MD, affiliate member of the ACC.. The Transcatheter Valve Therapeutics (TVT) 2013 conference kicked-off yesterday with “The Annual Mad Dash” presentation by Martin Leon, MD, FACC, who summarized the past year of transcatheter aortic valve replacement (TAVR) research in an impressive 20 minutes. According to Leon, there were a total of 835 TAVR manuscripts published in 2012 and 2013. Highlights included: A study by Dr. Vergnat, et al., using 3-D transesophageal echocardiography showing that TAVR resulted in better preserved mitral annular geometry as compared to...
Source: ACC in Touch Blog - June 13, 2013 Category: Cardiology Authors: Administrator Tags: Clinical Topics CV Meetings Special Topics Source Type: blogs

Renal denervation; saturated fat; heparin vs bivalirudin; dabigatran "real-life"
Renal denervation; saturated fat; heparin vs bivalirudin; dabigatran real-life (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - May 24, 2013 Category: Cardiology Authors: theheart.org Tags: This week in cardiology from heartwire Source Type: blogs