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
How to Reduce Your Heart Scan Score
Millions of people have undergone a CT heart scan that provides a heart scan or coronary calcium score. Unfortunately, people are then advised by doctors to take a statin drug, aspirin, a beta blocker or other combination of drugs that do NOT stop the 25-30% year-over-year rise in score. This eventually leads to heart attack or needing heart procedures like bypass surgery, angioplasty, or stent implantation, even death.
Doctors say that there is nothing you can do to stop this rise in heart scan score. What they are really saying is that there are no DRUGS or PROCEDURES that they can provide beyond the useless ones they p...
Source: Wheat Belly Blog - November 16, 2017 Category: Cardiology Authors: Dr. Davis Tags: Undoctored Wheat Belly Lifestyle calcium score coronary calcium score Dr. Davis gluten gluten-free grain-free grains heart attack heart disease heart disease reversal heart scan heart scan score Inflammation reverse heart sca Source Type: blogs
DAPT score – Dual Antiplatelet Therapy Score
DAPT score (Dual Antiplatelet Therapy Score) was developed to dichotomize patients after percutaneous coronary intervention [PCI] into those who will benefit from prolonged DAPT (score 2 or more) and those who are more likely to be harmed by DAPT (score less than 2). A recent study evaluated DAPT with aspirin and clopidogrel given for 2 years vs 6 months in 1970 patients undergoing PCI [1]. Primary efficacy outcomes were death, myocardial infarction or cerebrovascular accident. Primary safety outcome was significant bleeding. In this retrospective study they concluded that prolonged DAPT resulted in harm in patients with l...
Source: Cardiophile MD - November 14, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Do angioplasties and coronary stenting improve symptoms in patients with angina?
Last week, the results of ORBITA were published. This clinical trial tested coronary angioplasty and stenting versus optimal medical management in patients with single-vessel coronary artery disease. It was a resoundingly negative trial, meaning that adding stenting to drug management didn’t result in detectable clinical improvement. What was distinctive about this trial is that it used a sham procedure (i.e., placebo) control, which few trials testing surgery or a procedure use. The results of ORBITA emphasize how important sham procedure controls are, whenever they can be ethically used, and how resistant physicians ca...
Source: Respectful Insolence - November 13, 2017 Category: Surgery Authors: Orac Tags: Clinical trials Medicine angina angioplasty coronary artery bypass graft ORBITA percutaneous coronary intervention stent Source Type: blogs
Cangrelor – short acting P2Y12 inhibitor for intravenous use
Cangrelor is a short acting P2Y12 inhibitor for intravenous use. It is a directly acting non thienopyridine P2Y12 receptor antagonist analogous to adenosine triphosphate molecule, having a molecular weight of 88 Daltons. Plasma half life of cangrelor is 3 to 6 minutes only and the offset of its therapeutic action occurs in about one hour. If we are planning to use cangrelor in the cath lab, loading dose of oral P2Y12 inhibitor in the emergency department can be withheld. Cangrelor can be considered as Class IIb level of evidence A indication for those undergoing percutaneous coronary intervention (PCI) when they have not b...
Source: Cardiophile MD - November 11, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
12 Seconds of Placebo – An Outsider’s View of ORBITA
By, SAURABH JHA MD
The reactions of physicians 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 NY Times was predictably jejune and...
Source: The Health Care Blog - November 7, 2017 Category: Consumer Health News Authors: at RogueRad Tags: Uncategorized Source Type: blogs
Cardiology MCQ Test 6
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Source: Cardiophile MD - October 27, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Indeflator for coronary angioplasty
Indeflator
Indeflator is an inflation/deflation device used to inflate and deflate an angioplasty balloon during coronary angioplasty. The device has an inflation syringe, a connecting tube and a pressure gauge. The inflation syringe has a lock to maintain negative pressure in the balloon while introducing into the vessel and positioning across the lesion.
The pressure gauge monitors the pressure developed within the angioplasty balloon while the balloon is being inflated. This is needed for maintaining safety of the inflations. Each balloon has rated burst pressure and going above the rated burst pressure increases the ri...
Source: Cardiophile MD - October 26, 2017 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Source Type: blogs
Judkins right coronary catheter
Judkins Right Coronary Catheter
Judkins right coronary catheter has a sharp primary curve and a shallow secondary curve. The primary curve engages the right coronary ostium while the secondary curve engages the opposite wall of the aorta. The tip usually tapers to 5F size, irrespective of the nominal diameter of the catheter. Short form for Judkins right catheter is JR.
Judkins right coronary catheter is used primarily to engage the right coronary artery for coronary angiography. Very often it is used to enter the left subclavian artery to get an angio of the left internal mammary artery. It is also used to do renal angiog...
Source: Cardiophile MD - October 25, 2017 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Source Type: blogs
Coronary perforation – Cardiology MCQ
Pericardial or myocardial blushing is Grade — in Ellis classification of coronary perforation during percutaneous coronary intervention (PCI):
Grade I
Grade II
Grade III
Grade IV
Correct Answer: 2. Grade II
Ellis classification is based on angiographic appearance of the perforation.1
Grade I: Extraluminal crater without extravasation
Grade II: Pericardial or myocardial blushing
Grade III: Perforations of one or more millimeter diameter with contrast streaming or spilling
References
Ellis SG et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation...
Source: Cardiophile MD - October 24, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 5
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Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Fentanyl reduces effectiveness of ticagrelor for PCI – PACIFY RCT
Fentanyl is an opioid which is routinely used for periprocedural relief of during percutaneous coronary intervention (PCI). Intravenous morphine has been shown to reduce the absorption of P2Y12 inhibitors, presumably by delaying gastric emptying [1]. Platelet Aggregation with tiCagrelor Inhibition and FentanYl
(PACIFY) trial [2] evaluated the effect of intravenous fentanyl on the efficacy of ticagrelor. Ticagrelor plasma levels, platelet function and troponin levels were compared in a randomized trial with and without the use of fentanyl. There were 70 patients in this study who required PCI. Fentanyl arm had lower ticagr...
Source: Cardiophile MD - October 20, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 2
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Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Pharmaco-invasive strategy not a bad option – EARLY-MYO trial
(Representative image)
Pharmaco-invasive strategy means early thrombolysis for followed by early percutaneous coronary intervention (PCI). In case where the delay in getting PCI is likely to be longer than what is recommended, there is a role for pharmaco-invasive strategy. EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment–Elevation Myocardial Infarction) [1] randomized patients with ST Elevation Myocardial Infarction (STEMI) presenting within 6 hours, but with expected delay in getting primary PCI (PPCI) into pharmaco-invasive strategy with initial half d...
Source: Cardiophile MD - October 18, 2017 Category: Cardiology Authors: Johnson Francis Tags: Coronary Interventions Source Type: blogs
Early thrombolysis knocks out pPCI yet again . . . this time from Shanghai !
Primary PCI (pPCI) is a glorious revascularization strategy for STEMI practiced for over 2 decades but still has not proved its perceived mettle convincingly as a large population based strategy. In the mean time, the utility value of thrombolysis was systematically (Intentionally too! ) downgraded in the minds of both academic and public mind.
Truth can’t be buried for long. Series of revelations are coming up restoring the superiority of early thrombolysis over pPCI even in PCI capable centers.
In 2013, the high Impact STREAM trial argued for pharmacoinvasive approach within 3 hrs as it was at e...
Source: Dr.S.Venkatesan MD - October 18, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines cardiology -Therapeutics cardiology journals EARLY MYO trial circulation ppci vs thrombolysis primary PCI vs thrombolysis stream trial Source Type: blogs
