What is thrombolytic therapy for myocardial infarction? Cardiology Basics
Thrombolytic therapy used to be an important mode of early treatment of acute myocardial infarction. Though it has been largely superseded by primary angioplasty, thrombolytic therapy may still be useful in certain situations. It is still an important form of treatment in resource limited locations.
Myocardial infarction is usually due to sudden occlusion of a coronary artery by thrombus formation on a pre-existing partial obstruction by an atherosclerotic plaque. Plaque rupture with local thrombus formation is the usual mechanism. Dissolving the thrombus soon after the occurrence of a myocardial infarction can salv...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is myocardial stunning and hibernation? Cardiology Basics
Just as you can get stunned for some time if hit on the head, part of the myocardium can also stop functioning following transient coronary obstruction. This usually occurs following a myocardial infarction after which the occluded coronary artery gets opened up spontaneously or by thrombolytic therapy or primary angioplasty.
After a variable period of time, the stunned myocardium usually recovers full function. During the period of stunning, if a large part of myocardium is involved, the person may have features of heart failure due to decreased left ventricular systolic function. Myocardial stunning is the reason for he...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is myocardial viability assessment? Cardiology Basics
Myocardial viability means regions of myocardium which can recover its function if the blood supply is normalized. Viable myocardium will improve after restoring blood supply while non-viable myocardium will not.
So myocardial viability assessment is important in deciding whether the person will benefit from revascularization procedures like coronary angioplasty and coronary bypass surgery.
There are two types of viable myocardium, stunned myocardium and hibernating myocardium. Stunned myocardium needs only time to recover while hibernating myocardium needs restoration of blood supply. Stunned myocardium is transient dela...
Source: Cardiophile MD - October 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a nuclear stress test? Cardiology Basics
Usual stress test for the evaluation of coronary artery disease is a treadmill exercise ECG. It is commonly part of general health check-up and is widely available. But there are certain situations when the exercise ECG is not interpretable as in a person with left bundle branch block. Then a nuclear stress test will be useful.
While exercise ECG tells you that there is a probability of obstructions in coronary arteries, it most often does not identify the region of myocardium supplied by the obstructed vessel.
Nuclear stress test will tell you which is the region of myocardium that is affected. If there is already signif...
Source: Cardiophile MD - October 9, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How to know if chest pain is due to heart disease or not? Cardiology Basics
It is not always possible to be certain about the origin of chest pain just by its characteristics as the variation between individuals is quite a bit. There can be a lot of overlap between symptoms due to heart disease and disease of other nearby organs.
Still some general observations are possible regarding chest pain originating from the heart. The typical pain of cardiac origin is a central chest pain which occurs on walking or other forms of exercise, known as effort angina. This pain is caused by insufficient blood supply to a region of the myocardium. Effort angina is commonly due to significant obstruction to a co...
Source: Cardiophile MD - October 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Wellens ’ syndrome?
What is Wellens’ syndrome?
The original description of Wellens’ syndrome dates back to 1982 in which they identified a subgroup of patients admitted with unstable angina who are at high risk of development of an extensive anterior wall myocardial infarction. These patients with critical stenosis high in the left anterior descending coronary artery, had characteristic ST-T segment changes in the precordial leads on or shortly after admission. They noted this finding in 26 of their 145 patients admitted because of unstable angina. In spite of symptom control with nitroglycerine and beta blockade, 12 of the 16 pat...
Source: Cardiophile MD - September 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
OCT is not “ Obsessive compulsive tomography ”
This is the story of PCI to LAD from the customary bifurcation workshop for the budding experts, which ended up with a compulsive final OCT run-through, triggering a debate on what to do with the side branch.
What shall we do next?
Just balloon dilate the distal strut
Would consider a second stent. Maybe a TAP depending upon LCX morphology
At this stage, I would like to know the FFR or iFR across LCX Jail.
Get rid of this OCT, Let me have look at regular CAG. I bet I can make a better decision.
Leave it alone if the clinical status & profile is good
Leave it alone? Is it not an incomplete Job?
Def...
Source: Dr.S.Venkatesan MD - September 8, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coronary Imaging ILUMEN study oct opitical coherence tomography Source Type: blogs
History of PCI : Listen to Gruentzig ’ s prediction, that were spot on !
It brings a unique sense of greatness and gratitude to hear the voice of the father of Interventional cardiology decades after his demise.
Almost 4 decades ago, Andreas Gruentzig described "the ideal catheter" to me. He foresaw the development of FFR, hi-pressure balloons, aspiration catheters, stents, & more. His thoughts on physiologic measurement both during & post-procedure are thought-provoking. #AngioHistory pic.twitter.com/AiBKU6Tjxp— Angioplasty.Org (@angioplastyorg) September 3, 2022
The invention he made has evolved so much. Though, Dr. Gruentzig didn’t live to see any of them, the...
Source: Dr.S.Venkatesan MD - September 5, 2022 Category: Cardiology Authors: dr s venkatesan Tags: history of cardiology Histroy of medicine Dr Gruentzig Source Type: blogs
60 year old with vomiting, diarrhea, and syncope: is this Wellens? Is this type 2 MI?
Written by Jesse McLaren, with edits/comments by Smith and Grauer A 60 year-old patient with diabetes and ESRD presented with 24 hours of vomiting, diarrhea, weakness and then a syncopal episode. Vitals: RR 18, sat 98%, HR 103, BP 124/71 and temp 38.0. Here ’s their ECG: is this Wellens? There ’s borderline sinus tach, normal conduction, normal axis, and low voltages in the limb leads. The anterior leads have loss of R waves, mild convex ST segments and primary T wave inversion. In the context of QS waves, T wave inversion indicates old or subacute infarct, or reperfusion after signif icant infarc...
Source: Dr. Smith's ECG Blog - August 19, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Is Curative medicine an enemy of “ Preventive medicine ’ ?
No one will disagree, the most important medical quote of modern times is,
It is so unfortunate, the quote has almost become a silly cliche for every one of us including the physicians, patients. Preventive medicine always struggles to prevail over its starry-eyed colleague, curative medicine in spite of the fact, that cure is an assumption in many illnesses. Classic examples are diabetes, hypertension, and atherosclerotic disease. Many of the chronic diseases that afflict human beings have no complete cure. At best we can control them. All that we do is symptomatic and supportive treatment.
...
Source: Dr.S.Venkatesan MD - August 10, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized prevention is better than cure preventive medicine Source Type: blogs
Chest pain, RBBB but “STEMI Negative”: Is this a false cath lab activation, or a false cancellation?
A 90 year old with a history of atrial fibrillation presented with two weeks of intermittent retrosternal chest pain lasting minutes. An hour prior to presentation it became constant and more severe, accompanied by nausea and general weakness, and the paramedics brought them to the ED as a code STEMI. Heart rate was in the 50s and other vitals normal. What do you think? There ’s atrial fibrillation, a right bundle branch block, normal axis and normal voltages. RBBB should produce secondary ST depression and T wave inversion in the anterior leads with the RsR’ (as it does in V1). But here in...
Source: Dr. Smith's ECG Blog - July 18, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
New skills in ACS : Lessons from a foolish resident and an Intelligent consultant !
A brief conversation between an elite consultant and his fellow. (Caution: Grade 2 harsh language)
Hey Doc, why is this guy’s name not found in today’s angiogram list? Any Insurance issues?
No sir, he has every requirement. Thrombolysis was very successful, ST has regressed well and it is nearly isoelectric and only T is inverted. His LV function is normal. In fact, I am not able to pick up any WMA.
Aren’t you aware, that being fine is never a contraindication for a PCI ? Which book teach you like that?
No sir, It’s already beyond 48 hrs sir. What is the pur...
Source: Dr.S.Venkatesan MD - July 12, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acs management acute coronary syndrome stemi nstemi Source Type: blogs
New skills in ACS : Lessons from an Immature resident and an Intelligent consultant !
A brief conversation between an elite consultant and his fellow. (Caution: Grade 2 harsh language)
Hey Doc, why is this guy’s name not found in today’s angiogram list? Any Insurance issues?
No sir, he has every requirement. Thrombolysis was very successful, ST has regressed well and it is nearly isoelectric and only T is inverted. His LV function is normal. In fact, I am not able to pick up any WMA.
Aren’t you aware, that being fine is never a contraindication for a PCI ? Which book teach you like that?
No sir, It’s already beyond 48 hrs sir. What is the purpose of know...
Source: Dr.S.Venkatesan MD - July 12, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acs management acute coronary syndrome stemi nstemi Source Type: blogs
Instant easy save if you understand OMI, but incredibly dangerous if you only know STEMI. Readers of this blog will instantly understand this and save lives!
Written by Pendell MeyersA man in his 60s presented with 1 hour of acute chest pain. Vitals were within normal limits.Here is his triage ECG:30 minutes later:The ECG is a classic, pathognomonic ECG for acute LAD OMI. There is STE in V1 and de Winter morphology (hyperacute T wave with depressed ST takeoff / ST depression) in V2-V4. In the lateral leads V5-V6 and I and aVL there is STD that is likely in part reciprocal to the STE in V1. Also reciprocal STD in II and aVF, or potentially also de Winter morphology in inferior leads as well. With hyperacute T wave and STE in V1 and STD in V5-6, this constitutes an LAD OMI ...
Source: Dr. Smith's ECG Blog - July 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Bifurcation PCI : Physics & Philosophy of kissing & crushing strategy
Bifurcation PCI is a modern-day Cardiologist’s fascinating professional adventure within coronary arteries. Of course, the Intention is to do good for the patient. Bifurcation lesions (BFL) are a special subset of lesions, that looks challenging, more because of the potential biological aftermath following the delicate construction of a grade separator at a critical site. Mind you, it’s done within a live flowing artery and subsequently needs lifelong maintenance.
Strategies for BFL
Strictly committed* single stent strategy (Irrespective of what may come, LCX or LAD pinching let me tak...
Source: Dr.S.Venkatesan MD - July 5, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized bbc 1 definition nordic bifurcation pci carina cullotte dk crush mini crush pot ptca scai acc aha guidlines Source Type: blogs
