Shock index and modified shock index for prediction of myocardial damage and clinical outcome of STEMI
Shock index is the ratio of heart rate to systolic blood pressure which allows rapid bedside risk stratification [1]. Modified shock index is the ratio of heart rate to mean arterial pressure [2]. Reinstadler SJ et al [2] used these indices to predict the myocardial damage and clinical outcome of ST segment elevation myocardial infarction (STEMI). They found that STEMI patients with elevated shock index had more severe myocardial and microvascular damage and it was associated with major adverse cardiac events (MACE) at 1 year.
This multicenter study analyzed around eight hundred patients dicotomized to an admission shock ...
Source: Cardiophile MD - June 6, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Left Bundle Branch Block, Severe Chest pain, Previous Normal Angio. What is going on?
A middle-aged woman with idiopathic cardiomyopathy and biventricular failure, with previous EF of 15%, presented withsudden onset severe substernal chest pain. She had LBBB with a wide QRS, and therefore was a candidate for biventricular pacer for cardiac resynchronization, but when they had inserted her pacemaker, they could not get the LV lead into place (technical difficulties). Therefore, she had a typical RV pacer.She had arecent near perfect angiogram, described below. Here is her initial ED ECG:1. Is it paced?2. What do you notice compared to the previous, below?3. Is there any...
Source: Dr. Smith's ECG Blog - June 4, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.
One of our graduates, Rochelle Zarzar, who is now an education fellow, sent me this from one of the hospitals she works at now:An elderly woman presented with chest pain. She had been nauseous the night before and did not feel well, then awoke 2 hours prior with chest pain.She had had a completely normal angiogram 3 months prior.Here is that angiogram report:The left main coronary artery is normal.Left anterior descending is a type 3 vessel and is normal.Left circumflex is nondominant and normal.The right coronary artery is dominant and normal.The nurses immediately recorded an ECG. This was 2 hours after the o...
Source: Dr. Smith's ECG Blog - May 29, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Management of pulmonary artery perforation during balloon angioplasty
Management of perforation of a pulmonary vessel is on the same lines as that of any other vessel like coronary perforation during percutaneous coronary intervention. First and foremost is to prevent a rupture before it actually occurs! Proper wire positioning within the lumen and avoiding a segment with total occlusion and no distal flow are two important aspects of prevention. But if the total occlusion is involving a large segment, we may have to proceed with special precautions.
In the knuckle wire technique, a loop is formed at the distal end of the wire while trying to cross a total occlusion. This loop will prevent ...
Source: Cardiophile MD - May 27, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Peripheral Interventions balloon tamponade ECMO knuckle wire technique PEEP Source Type: blogs
MALE – Major adverse limb events
MALE – Major adverse limb events
MALE – Major adverse limb events is considered in the setting of peripheral arterial disease and peripheral interventions. It includes major amputation, reintervention which could be surgical or repeat angioplasty. Major amputation is defined as amputation above the ankle. Amputation at the tarso-metatarsal level (Lisfranc level) or below is not considered as a failure of limb salvage [1].
Major vascular reinterventions are thrombectomy, thrombolysis or major surgical proceudre – new bypass graft, jump/interposition graft revision in the index limb [2].
In the COMPASS (Ca...
Source: Cardiophile MD - May 26, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Peripheral Interventions Source Type: blogs
Why routine thrombus aspiration is prohibited in STEMI ?
It was 1912 , Titanic had just sank off the Atlantic . When the world attention was elsewhere , An unassuming young Dr.Herrick J.B silently working in his Michigan lab inquisitively proposed thrombus occluding the coronary artery is the chief culprit in acute myocardial Infarction.It took seven more decades when Davis et all from Glasgow .UK. proved it by doing dramatic angiographic studies soon after STEMI in year 1979.
Now, even after 100 years , we, the confused cardiologists debate endlessly in glamorous global conclaves in exotic locales whether to aspirate these humble looking thrombus, threatening to...
Source: Dr.S.Venkatesan MD - May 12, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Criteria Cardiology -Therapeutic dilemma cardiology wisdom Coronary angiogram cost effectiveness in cardiology STEMI STEMI -Managment STEMI-Primary PCI Thrombolysis Thrombolysis -Tips herrick davis coronary thrombolysis v Source Type: blogs
Real-Time Intravascular Imaging for PAD by Avinger: Interview with CEO Jeff Soinski
The objective of the clinical trial was to demonstrate that Pantheris can be used to effectively remove plaque from diseased lower extremity arteries while using on-board visualization as an adjunct to fluoroscopy. Two groups of patients were treated in VISION: (1) optional roll-ins, which are typically the first two procedures at a site, and (2) the primary cohort, which are the analyzable group of patients. Based on final enrollment, the primary cohort included 130 patients.
VISON’s primary efficacy endpoint required that at least 87% of lesions treated by physicians using Pantheris have a residual stenosis of less...
Source: Medgadget - April 24, 2018 Category: Medical Devices Authors: Michael Batista Tags: Cardiology Exclusive Radiology Vascular Surgery Source Type: blogs
Twitter-Based Medicine: How Social Media is Changing the Public ’s View of Medicine
By BENJAMIN WERTZER, MD
Doctors can be two-faced. This isn’t necessarily a negative attribute. Doctors have distinct personas for our patients and our colleagues. With patients, doctors strive for a compassionate but authoritative role. However, with each other, doctors often reveal a different demeanor: thoughtful and collaborative, but also opinionated and even sometimes petty. These conflicts are often the result of our struggle with evidence-based medicine. The modern practice of evidence-based medicine is more than the scientific studies we read in journals. Medicine doesn’t just change in rational, data-driven in...
Source: The Health Care Blog - April 17, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
An Idiot ’ s approach to STEMI presenting at (or ) beyond 48 hours !
When half a dozen guidelines from extremely evidence based “Esteemed cardiac societies” decide to confront an Incomprehensive cardiologist , there is no other way , but to create a personalised i-Guidelines on STEMI !
*(i-Idiotic)
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - March 19, 2018 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -Interventional -PCI Cardiology -Therapeutic dilemma cardiology -Therapeutics STEMI -Managment acc esc aha guidelines scai on pci culprit vs non culprit pci decision cto deferred pci deferred ptca del Source Type: blogs
ST-Elevation in aVR with diffuse ST-Depression: An ECG pattern that you must know and understand!
This case comes from Sam Ghali (@EM_RESUS). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs:HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98%This is his 12-Lead ECG:He is in atrial fibrillation with a rapid ventricular response at a rate of around 140 bpm. There are several abberantly conducted beats. There is ST-Elevation in aVR of several millimeters and diffuse ST-Depression with the maximal depression vector towards Lead II in the limb leads and towards V5 in the precordial leads.ECG reading is all ab...
Source: Dr. Smith's ECG Blog - February 28, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cath lab tips : Post dilatation is an unique “ Art ” . . . can ’ t learn it from textbooks or workshops !
In the modern era of cardiology, PCI has become the single therapeutic modality that determines the survival of both cardiologists and possibly their patients! The procedure is all about launching a metal coil inside the coronary artery of a live beating heart.
Millions of diseased and (not much) diseased coronary arteries are serviced (either re/deconstructed ) world-wide on a day-to-day basis.The benefits of the modality is directly related to the wisdom of treating cardiologist and patient’s luck than the original severity of the disease. However, with greatly improved coronary metallurgy , well assist...
Source: Dr.S.Venkatesan MD - December 24, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized post dilatation pre vs postdilatation ptca post dilatation Source Type: blogs
A reaction to ORBITA: Keep on stenting, judiciously
Physicians’ reactions to ORBITA — a blinded, randomized controlled trial (RCT) from Britain with a sham arm comparing percutaneous coronary intervention (PCI) to placebo in patients with stable angina — are as fascinating as the cardiac cycle. There were murmurs, kicks and pulsating jugulars. Though many claimed to be surprised and many unsurprised by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, and some became defensive and bisferious.
No shame in sham
The coverage of the trial in the The New York Times was predictably jejune and hyperbolic. Predict...
Source: Kevin, M.D. - Medical Weblog - December 10, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dr-saurabh-jha" rel="tag" > Dr. Saurabh Jha < /a > Tags: Conditions Cardiology Source Type: blogs
Orbiting ORBITA
By ANISH KOKA, MD
I’m sitting amidst a number of cardiologists to go over the most recent trials presented at the interventional cardiology conference in Denver. The cardiology fellow presenting goes quickly through the hors de oeuvres until finally getting to the main course – ORBITA.
ORBITA sought to test the very foundations interventional cardiology was built on – the simple idea that opening a stenosed coronary artery was good for patients. The trial was a double blind randomized control trial of patients with tightly stenosed arteries who either had a stent placed or had a sham procedure. Before the resul...
Source: The Health Care Blog - December 4, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Anish Koka cardiology Orbita Source Type: blogs
Echocardiographic assessment of myocardial viability
Diastolic wall thickness will give an idea regarding the myocardial viability. Thin and hyperdense myocardium is likely to be scarred and non viable. Dobutamine stress echocardiography documents the contractile reserve of the myocardium and hence indicate viability. Myocardial perfusion is assessed by myocardial contrast echocardiography. Strain and strain rate imaging is done by tissue Doppler and speckle tracking. There are various methods of assessing diastolic dysfunction using Doppler and tissue Doppler echocardiography.
End diastolic wall thickness (EDWT)
End diastolic wall thickness (EDWT) is one of the simplest me...
Source: Cardiophile MD - November 17, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Myocardial viability assessment
The term viable myocardium is applied to myocardium with a potentially reversible contractile dysfunction in patients with coronary artery disease. It can be divided into stunned myocardium and hibernating myocardium. Stunned myocardium has prolonged contractile dysfunction after a transient ischemic episode and coronary reperfusion. This automatically recovers over a period of time. Stunned myocardium is commonly noted after thrombolysis and primary percutaneous coronary intervention. Hibernating myocardium has reduced contractile function due to persistently impaired coronary blood flow. Hibernating myocardium regai...
Source: Cardiophile MD - November 16, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
