Should I participate in a cardiac rehabilitation program?
Cardiac rehabilitation (CR), or “cardiac rehab,” is a multifaceted, medically supervised program proven to improve heart health and outcomes in people with certain types of cardiovascular disease. CR revolves around three major components: an individualized exercise and training program, education on topics related to heart health, and stress reduction.
CR is currently recommended for the following diagnoses: angina (chest pain); heart attack with or without angioplasty or bypass surgery; heart failure with reduced ejection fraction (HFrEF); and heart surgery including heart valve procedures or heart or heart/lung tran...
Source: Harvard Health Blog - October 10, 2019 Category: Consumer Health News Authors: Hicham Skali, MD, MSc, FACC Tags: Exercise and Fitness Health Heart Health Source Type: blogs
Is FFR heart rate dependent ? If yes, how significant it is?
FFR is the ultimate hemodynamic test that measures the physiological Impact of lesions. Just pass a manometer tipped wire across the lesion and note the pressure drop (with or without Adenosine) All you have to remember is two cut off values .8 for FFR and .9 for IFR. Abracadabra . . . yes you got the answer , whether to proceed with PCI or not? It’s as simple as that. We are no longer blind to physiology to which many coronary purists often criticize us.
Coronary physiology simplified
Now , answer this question.
Is FFR heart rate dependent? If yes, how significant it is?
This simple question on coronary physiology...
Source: Dr.S.Venkatesan MD - October 2, 2019 Category: Cardiology Authors: dr s venkatesan Tags: fame study ffr quantitative coronary angiogram fractional flow reserve ffr ifr IFR QFR instantaneous flow reserve Limitations of FFR pressure wire channel in gruentzig original ptca balloon zurich Source Type: blogs
How are hospitals supposed to reduce readmissions? Part II
By KIP SULLIVAN, JD
The
notion that hospitals can reduce readmissions, and that punishing them for
“excess” readmissions will get them to do that, became conventional wisdom
during the 2000s on the basis of very little evidence. The Medicare Payment
Advisory Commission (MedPAC) urged Congress to enact the Hospital Readmissions
Reduction Program (HRRP) beginning in 2007, and in 2010 Congress did so. State
Medicaid programs and private insurers quickly adopted similar programs.
The rapid adoption of readmission-penalty programs without evidence confirming they can work has created widespread concern that these prog...
Source: The Health Care Blog - October 1, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy CMS hospital readmissions Hospital Readmissions Reduction Program HRRP Kip Sullivan MedPAC Source Type: blogs
A man in his 70s with chest pain during a bike ride
Case written and submitted by Ryan Barnicle MD, with edits by Pendell MeyersWhile vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding. It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. It was radiating to his bilateral upper arms. It was associated with nausea but he denied dyspnea, dizziness, and headache.He explained that he had the same chest pain the day prior as well, on and off....
Source: Dr. Smith's ECG Blog - September 29, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
DM cardiology course suffers from a 50% entry block … A NEET angioplasty done.
The most premier course in medicine, DM cardiology just got an entry makeover.
The qualifying mark was lowered to 20% from the current 50th percentile The reason is many private medical college seats went vacant after the Initial counselling in NEET superspeciality exams.
Becoming a cardiologist was a dream come true for those days for us. “You have to read the red covered 3rd edition Brunwald and all clinical chapters from Hurst for two full years” before even to think of writing DM entrance, my senior used to tell me in late 1980s.Yes, life may still be tough in post graduate entrance but, there is an exclus...
Source: Dr.S.Venkatesan MD - September 8, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Doctors Perform First Minimally Invasive Remote Robotic Cardiac Procedure
Clinicians in India have teamed up to demonstrate the feasibility of having a physician remotely perform percutaneous coronary intervention (PCI) procedures. Using the CorPath GRX, an FDA cleared cath lab robot that lets physicians stay away from the radiation produced by fluoroscopes, the team from the Apex Heart Institute in Ahmedabad positioned the control mechanism in a building 20 miles away from where the patients were to be treated.
They were then able to perform five separate procedures, including dilation with angioplasty balloons and positioning stents within the treated area. All of the procedures were c...
Source: Medgadget - September 6, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiology Radiology Source Type: blogs
FAQs in STEMI : Why is the 3 hour gap recommended before pharmaco Invasive strategy?
Background STEMI knowledge check : Evidence-based Ignorance
I think , It was unfortunate, In the management of STEMI , the two popular strategies of myocardial reperfusion was made to fight with each other as if they are perennial enemies for over two decades. Suddenly, someone with a rare coronary insight thought, why fight each other , they can have a friendly hug and work together. That brought the concept of pharmco -Invasive approach or strategy(PIA) backed up by STREAM, FAST-MI, and TRANSFER AMI studies.Yes, it appears to work well and devoid of all the early adverse events of pPCI. (Much to the dismay of ardent fans...
Source: Dr.S.Venkatesan MD - August 14, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology - Animations Cardiology -Interventional -PCI Cardiology -unresolved questions cath lab tips and tricks Infrequently asked questions in cardiology (iFAQs) open artery hypothesis STEMI STEMI -Managment ST Source Type: blogs
How does acute left main occlusion present on the ECG?
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. In these ...
Source: Dr. Smith's ECG Blog - August 8, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Would you have given thrombolytics to this NSTEMI patient?
Case submitted by Dr. James AlvaA middle aged male called EMS for chest pain. EMS arrived and confirmed that the patient was complaining of chest pain and shortness of breath.They recorded this prehospital ECG:What do you think?Normal QRS complex rhythm with hyperacute T-waves in V2-V6, I and aVL. Slight STE in V2 only, with significant STD and thus de-Winter pattern in V4-V6. Leads II and III show reciprocal depression of the ST segment (II) and T-wave (III). This is diagnostic of acute myocardial infarction of the anterolateral walls, with the most likely etiology being Occlusion of the LAD. In other words, this ECG show...
Source: Dr. Smith's ECG Blog - July 6, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Predictions and Parachutes
By SAURABH JHA, MD
What does it take to create a decision rule? In this episode of Radiology Firing Line podcast Saurabh Jha (@RogueRad) has a discussion with Robert W. Yeh MD MBA about the deep thought and complex statistics involved in creating a decision rule to guide therapy which have narrow risk-benefit calculus, specifically a rule for how long patients should continue dual anti-platelet therapy after percutaneous coronary intervention. They also discuss the motivation behind the legendary, and satirical, parachute RCT published in the recent Christmas edition of the BMJ, which delighted satirists all over the wo...
Source: The Health Care Blog - May 31, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Radiology Firing Line Podcasts RogueRad @roguerad decision rule Robert Yeh Saurabh Jha Source Type: blogs
Drug eluting stent vs drug coated balloon in primary PCI
Paclitaxel coated balloon angioplasty was compared with drug eluting stent in acute ST elevation myocardial Infarction (STEMI) in the REVELATION ( REVascularization with paclitaxEL-coated balloon angioplasty versus drug-eluting stenting in acute myocardial infarcTION) Trial [1]. Drug coated balloons for angioplasty aims at reducing the potential disadvantages of stent implantation like stent thrombosis. It is thought improve the restenosis compared to plain old balloon angioplasty.
REVELATION was a single center prospective randomized trial in patients with STEMI. Those with a new culprit lesion in a native coronary arte...
Source: Cardiophile MD - May 25, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
New Device Monitors Blood Flow Through Radial Artery to Prevent Occlusions Post PCI
Following transradial percutaneous coronary interventions (PCI), the radial artery can occasionally occlude, potentially resulting in serious complications. Radial occlusion is treated by applying compression, but clinicians have no idea whether nor how much blood is flowing through the artery. Moreover, once an occlusion happens in the radial artery, it cannot be used again as an access site in the future.
A new device called IdaFlo Tr from IdaHealth, a company out of Bonita Springs, Florida, has just been revealed at the annual meeting of the European Association of Percutaneous Cardiovascular Interventions (EuroPCR) in ...
Source: Medgadget - May 24, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
Virtue Sirolimus-Eluting Balloon Helps Prevent Restenosis without Stents
When plaques cause arterial vessels to narrow, intravascular balloons are usually used to widen the lumen. Sirolimus and its analogues are drugs that are commonly used to prevent restenosis. Because blood flows rapidly through, stents coated with the drug have been used to treat the area by slowly releasing sirolimus and the like into the surrounding vascular tissue. The problem is that the stent has to stay, which may create its own side effects.
Now a new device, called Virtue Sirolimus-Eluting Balloon (SEB), from Orchestra BioMed, a company based in New Hope, Pennsylvania, may soon be a new treatment option without havi...
Source: Medgadget - April 25, 2019 Category: Medical Devices Authors: Editors Tags: Cardiology Source Type: blogs
Optical frequency domain imaging (OFDI)
Optical frequency domain imaging (OFDI) is a novel second generation optical coherence tomography (OCT) derived imaging method [1]. It has substantially higher speed of image acquisition compared to first generation time domain OCT. OFDI can allow rapid imaging for detection of coronary strut coverage with a much higher precision compared to intravascular ultrasound. Axial resolution of OFDI is in the range of 10-20 microns.
OPINION trial compared optical frequency domain imaging vs. intravascular ultrasound (IVUS) in percutaneous coronary intervention [2]. It was a prospective, multicentre, randomised, active-controlled...
Source: Cardiophile MD - April 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Source Type: blogs
Tack System for Repair of Angioplasty Endovascular Tears FDA Approved
Balloon catheters have revolutionized the treatment of vascular diseases, but when they’re used to push plaque against the walls of vessels tears can form. These tears can have significant impact on the integrity and hemodynamics of vessels and therefore on the health of patients. Stents can be used to address these, but stents are typically much longer than the tears and multiple tears would require multiple stents, each with potential to create side effects down the road.
Intact Vascular, a company based in Wayne, Pennsylvania, landed FDA approval for its novel Tack system for treatment of endovascular tears formed...
Source: Medgadget - April 17, 2019 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Radiology Vascular Surgery Source Type: blogs
