Non-Left Main Bifurcation Lesion PCI Strategies
Bifurcation lesions may be noted in almost one third of cases for percutaneous coronary intervention. Outcomes for bifurcation lesions are worse compared to non-bifurcation lesions. The two important strategies for addressing a coronary bifurcation lesion are planned one stent strategy or provisional stenting and elective two stent strategy. In provisional stenting, side branch is stented only if unavoidable.
A multicenter registry of 2044 patients compared the two strategies in non-left main bifurcation lesions. There were 1551 bifurcation lesions of left anterior descending coronary artery and 493 non-LAD bifurcation le...
Source: Cardiophile MD - April 16, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
Localising WPW : Take it EASY always
If some body is struggling with same problem, say for over three decades , there is something seriously wrong with the way we deal with the problem or there is some problem with the problem itself .
How do you localise accessory pathway in WPW syndrome from 12 lead ECG ? is one such entity, This question is asked exclusively in cardiology board exams. Now a 2023 paper from EUROPACE claims, it has come out with a simple algorithm bettering all the previous ones. Please check it for yourself.
One thing we can say with conviction is most of these embryological remnant pathways are posteriorly or laterally dragg...
Source: Dr.S.Venkatesan MD - April 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized WPW syndrome 12 LEAD ECG LOCLISATION IN WPW SYNDROME arruda scheme easy wpw algorithm Source Type: blogs
Localising WPW : Take it EASY
If some body is struggling with same problem, say for over three decades , there is something seriously wrong with the way we deal with the problem or there is some problem with the problem itself .
How do you localise accessory pathway in WPW syndrome from 12 lead ECG ? is one such entity, This question is asked exclusively in cardiology board exams. Now a 2023 paper from EUROPACE claims, it has come out with a simple algorithm bettering all the previous ones. Please check it for yourself.
One thing we can say with conviction is most of these embryological remnant pathways are posteriorly or laterally dragg...
Source: Dr.S.Venkatesan MD - April 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized WPW syndrome 12 LEAD ECG LOCLISATION IN WPW SYNDROME arruda scheme easy wpw algorithm Source Type: blogs
A man in his 50s with chest pain
Sent by anonymous, written by Pendell MeyersA man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Vitals were within normal limits.Here is his triage ECG at 0343:What do you think?Meyers interpretation: Diagnostic of LAD OMI, with hyperacute T waves in a large LAD distribution including precord...
Source: Dr. Smith's ECG Blog - March 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What is the ECG Diagnosis?
I came across this ECG while reading ECGs for Cardiologs in order to train the Cardiologs Deep Convolutional Neural Network. I don ' t have any clinical information or any other associated ECGs on this case, but wanted to post it here because it is interesting and it ispathognomonic.What is it?This is a proximal LAD Occlusion. First, there are hyperacute T-waves in V2-V4. These are preceded by ST depression and are de Winter ' s T-waves, though somewhat atypical. There is also a hyperacute T-wave in aVL with subtle STE. There is reciprocal ST depression in II, III, and aVF: it is more vis...
Source: Dr. Smith's ECG Blog - February 10, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Coronary Angioplasty
Initial part of the video clip shows left coronary angiogram with total occlusion of left anterior descending coronary artery. Annotations are given in still frames in between. Next view shows inflation of balloon in LAD. Check angiogram after initial balloon dilatation is shown next. Post stenting angiograms in multiple views follow, to look for any residual luminal stenosis or potential complications of angioplasty.
Coronary Angioplasty (Source: Cardiophile MD)
Source: Cardiophile MD - February 4, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Source Type: blogs
QS-wave in V2: 2 cases, different paradigms lead to different treatment times (STEMI - NSTEMI vs. OMI - NOMI)
Submitted by anonymous, written by Pendell Meyers. Additional case by Smith.Case 1A middle aged woman presented with acute chest pain and shortness of breath, unclear time since onset, and likely with episodic symptoms off and on throughout the day. Her vitals were within normal limits.ED1 @1512What do you think?Meyers: Very clear and specific for acute LAD OMI, with hyperacute T waves in the LAD distribution including leads V2-V6, II, III and aVF. Only very slight STE which does not meet STEMI criteria at this time. I am immediately worried that this OMI will not be understood, for many reasons including lack of suf...
Source: Dr. Smith's ECG Blog - January 28, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Compliant vs noncompliant balloon catheters
Compliant balloon will increase in diameter as the pressure in the indeflator increases, as the name implies. They are made of polyurethane or silicone and can be inflated up to several times the nominal size. Compliant balloon is used when there is a need for the expanded balloon to fully conform to the vessel lumen or occlude it.
On the other hand, noncompliant balloons are high pressure balloons made of polyester or nylon. They can exert high pressure to expand up to a specific diameter, but not significantly beyond that. They can be used to crack calcified lesions and expand stents.
Then there is the concept of semi-c...
Source: Cardiophile MD - January 10, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
A woman in her 50s with acute chest pain
Submitted and written by Anonymous, edits by Meyers and SmithA 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache.Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 FTriage ECG:ECG Interpretation:Sinus rhythm with normal QRS. There is slight STE in V1, V2, and aVR, with STD in V3-V6, I, aVL, and II. There are T waves in lead III which are suspicious for hyperacute T waves, with reciprocal negative large T wave inversions in aVL. I do not think this ECG is by itself diagnostico...
Source: Dr. Smith's ECG Blog - January 6, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What is Door in – Door Out Time?
What is Door in – Door Out Time?
Door in door out time is applicable when a person presents with ST segment elevation myocardial infarction to a centre which does not have the facility to perform primary angioplasty by percutaneous coronary intervention or PCI.
Recommended door in – door out time in ST elevation myocardial infarction presenting to non-PCI capable center is less than 30 minutes. Primary angioplasty being the best option to open up the infarct related coronary artery, it has to be done at the earliest. So time should not be lost by undue observation at a non PCI capable centre. When the person presen...
Source: Cardiophile MD - November 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Pulmonary angiography
Pulmonary angiography can be done by introducing a guidewire initially followed by a modified pigtail catheter like Grollman catheter, under fluoroscopic guidance.
Grollman catheter has a gentle rightward curve and an additional right angled leftward curve proximal to the side holes. The tip of the Grollman catheter has a pigtail shape.
Schematic diagram of modified pigtail Grollman catheter
Non-ionic contrast can be injected into the right and left pulmonary arteries to get corresponding angiograms. The guidewire and catheter are introduced through the femoral vein and directed to the pulmonary artery through the inferio...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex
Written by Pendell MeyersFamily of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. She was alert and oriented and hypotensive with initial BP 70/50. A 12 lead ECG was obtained by EMS and is shown below:What do you think?There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in mo...
Source: Dr. Smith's ECG Blog - November 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
What is cardiogenic shock? Cardiology Basics
When the heart is not able to pump enough blood for perfusing the vital organs and the blood pressure falls, it is known as cardiogenic shock. Most important cause of cardiogenic shock is an acute myocardial infarction. Cardiogenic shock can also occur in other conditions like a fulminant myocarditis. In case of myocardial infarction, it is more likely to occur in those who are older, having multivessel coronary artery disease, and in those with a previous myocardial infarction. Cardiogenic shock is a potentially life threatening condition and needs urgent treatment. Even with treatment about half of those with cardiogeni...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is carbon dioxide angiography? Cardiology Basics
Carbon dioxide angiography is done using carbon dioxide injection into the blood vessel. Usually iodine containing radiocontrast dyes are injected into the blood vessels and continuous X-ray imaging done, to obtain angiograms.
Contrast material is needed to visualize the blood vessel separately from the other body tissue. But usual iodinated radiocontrast dyes have a potential risk of causing acute kidney injury. This is more so in those with already impaired renal function. It is in this situation that carbon dioxide angiography is usually considered.
Usual angiograms appear dark while carbon dioxide angiogram look...
Source: Cardiophile MD - October 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is DM Cardiology? Cardiology Basics
DM Cardiology (Doctor of Medicine – Cardiology) is a three year full-time course conducted at various medical colleges and institutes of national importance in India. Cardiology is the branch of medicine dealing with cardiovascular disorders.
Selection to the various medical colleges is by the National Eligibility Cum Entrance Test – Super Specialty (NEET-SS), while that to institutes of national importance is by Institute of National Importance Combined Entrance Test (INI CET).
NEET-SS is conducted by the National Board Of Examinations In Medical Sciences, New Delhi. INI CET is conducted by All India Institute of Med...
Source: Cardiophile MD - October 16, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
