Bifurcation PCI : Physics & Philosophy of DK crush technique
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
Magnetic Steering System for Guidewires
Percutaneous coronary intervention is an incredibly useful technique to minimally invasively investigate and treat cardiac issues, such as blockages in the coronary arteries, but it requires a significant amount of skill to perform safely and effectively. Manipulating a guidewire through the tortuous vasculature is not for the faint hearted, with the possibility of perforating a vessel always near. Moreover, as the procedure is frequently undertaken at the bedside, it is impossible for the clinician to avoid X-ray exposure.
Now researchers at Daegu Gyeongbuk Institute of Science and Technology in Korea have developed a ...
Source: Medgadget - June 28, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Cardiology Radiology Vascular Surgery Source Type: blogs
A man in his 30s with chest pain and a normal bedside echo, without wall motion abnormality
In conclusion — our THANKS to Drs. Nicacio and Meyers for presenting today ' s case. As interesting as I found the initial ECG to be — the KEY point in today ' s case is that identification of suspicious (albeit indefinite) ECG findings in this patient with typical unrelieved chest pain merited timely cath (which was done within 15 minutes of ED presentation) — and this confirmed the need for prompt revascularization. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 17, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain, trop > 50,000 but only 30% LAD stenosis on angiogram: what's the diagnosis?
Conclusion: Correlation of the recurrence of this patient ' s chest pain with evolving ECG changes (loss of anterior R waves, waxing and waning of Q waves — and dynamic change in shape and relative amount of ST segment deviation) — was enough to justify the determination of an " acute STEMI " despite no more than borderline ECG criteria for this diagnosis and non-obstructive coronary disease on 2 catheterizations. Clinically — Stenting of the non-obstructive 60% mid-LAD lesion effectively prevented further infarction. Dependence on mill...
Source: Dr. Smith's ECG Blog - June 5, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Is there Intracellular edema in congestive heart failure ?
I am unable to answer this question confidently even after spending 25 years in the specialty of cardiology. I thought, the answer was yes. Reality is definitely different. Such is the complexity in the biology of the fluid and circulatory systems. The heart’s function doesn’t seem to end with just pumping 6 liters of blood every minute, ultimately, it has to handle a huge load of water as well with delicate coordination with the kidney. (ANP,& RASS feedback). It is fascinating to note, that the heart transforms into a powerful endocrine organ as and when it is necessary.
Read further, with a caution: (The...
Source: Dr.S.Venkatesan MD - May 31, 2022 Category: Cardiology Authors: dr s venkatesan Tags: cardiac failure edema in heart failure Source Type: blogs
A man in his 40s who really needs you to understand his ECG
Written by Pendell MeyersA man in his 40s presented for " left sided chest pain sudden onset yesterday when sneezing and coughing that is worsened with inspiration. " He also complained of associated SOB, dizziness, jaw pain, and back pain, which he described as " muscle spasms. " He has also had rhinorrhea and cough for 1 week. Also, left hand numbness today. He went to urgent care for evaluation. An ECG was performed there (unavailable) which reportedly was abnormal, so EMS was called to urgent care to take him to the ED.On EMS arrival, they noted the patient vomited then became unresponsive. He was reportedly...
Source: Dr. Smith's ECG Blog - May 1, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
How is RCA angina different from LAD angina ?
William Heberden first introduced the term angina to the medical community in 1778. His descriptions became immortal. Still, no one would ever know what was the angina-related artery, Heberden was alluding to.
Now, some jobless cardiologist is asking this question after 200 years. How is angina from the LAD system differ from the RCA system? or let me put it another way, How does angina of anterior circulation (LAD) differ from posterior circulation (RCA/LCX)? Though there is distinct hemodynamic profiling of RCAvs LAD ACS, surprisingly, cardiology literature does not answer the chest pain aspect of it. One rare stud...
Source: Dr.S.Venkatesan MD - April 26, 2022 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome angina cardiac embryology Cardiology - Clinical Cardiology -Mechnisms of disease Clinical cardiology Source Type: blogs
A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?
Case written and submitted by Brandon Fetterolf MD, edits by MeyersA woman in her early 30s with multiple autoimmune disorders including vasculitis presented with 2-3 hours of mid-left side chest discomfort with radiation to neck and left arm and associated with nausea, diaphoresis and dizziness. Initial ECG on presentation at 1554 (no prior for comparison):What do you think is happening to his 30s woman? The ECG shows NSR with a normal QRS except for poor R wave progression and pathologic QS-waves in V2-3. There is STE and hyperacute T waves in V2, I, and aVL with reciprocal STD in II, III, and aVF. This is...
Source: Dr. Smith's ECG Blog - April 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
False cath lab activation or false cancellation?
Written by Jesse McLarenA 40 year old developed sudden chest pain radiating to the jaw, with diaphoresis and vomiting. What do you think?What do you think? There ’s normal sinus rhythm with normal conduction, normal axis, normal R wave progression and normal voltages. There are hyperacute T wave in I/aVL and possibly V5-6, with reciprocal change in III. There’s also ST depression in V1-3. The computer interpretation labeled this ECG as “nonspecific”, and it does not meet STEMI criteria. But there are ischemic abnormalities in the majority of leads that add up to an ECG diagnostic of posterolateral Occlusion MI...
Source: Dr. Smith's ECG Blog - March 16, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Curve of wisdom in ACS : Open Cath lab doors may mean nothing , if the windows are closed !
“We have a 24/7 cath lab with an open door policy. Our cardiologist arrives at 15 minutes’ notice. Door to balloon time is less than 60-90 minutes”,
“Great, so, you can always offer a successful treatment for STEMI”
“No, that we can never guarantee.”
“Oh, It Is not the answer, I expected”
“I agree, it sounds disappointing, but. truths are less pleasing. What I am trying to say is, there are a number of factors other than the availability of a grand cath lab and agile and effortless hands, that try to reperfuse the myocardium in distress. I ...
Source: Dr.S.Venkatesan MD - February 1, 2022 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome acute coronary syndrome Cardiology -Criteria Cardiology -guidelines cardiology -Therapeutics Cardiology -unresolved questions acc aha esc scai gudilines acs acs management evidence based cardiology open artery h Source Type: blogs
Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays
Written by Pendell MeyersA man in his early 60s presented with acute chest pain rated 10/10 with associated nausea and vomiting with known history of multivessel CAD. He presented at 2300 with onset of symptoms at 2230. He was awoken from sleep by the symptoms, which were identical to prior MI for which he received a stent years ago. On arrival his heart rate was 43 bpm and blood pressure 91/62. Atropine and IV fluid was given.Here was his triage ECG:What do you think? Baseline below for comparison, but try first without it.His baseline ECG was available on file:The presentation ECG shows diagnostic evidence of poste...
Source: Dr. Smith's ECG Blog - December 1, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Shark fin post arrest: do you understand the ECG?
Case submitted by Dr. Daryl Williams, written by Pendell Meyers, peer reviewed by Smith and BraceyA physician bystander witnessed a middle-aged or slightly elderly man suddenly collapse while walking down the street, very close to the hospital. The physician immediately started CPR and called EMS. EMS arrived quickly and found the patient to be in VFib. After several shocks the patient achieved ROSC.A minute or so after arrival to the ED, he went back into VFib and was immediately shocked back out into sinus rhythm.His EMS ECG during initial ROSC was available for the ED team:Here is his ED ECG:What do you think?Both ...
Source: Dr. Smith's ECG Blog - November 22, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Drug coated balloons in coronary artery disease
Drug coated balloons are a novel therapeutic option in certain situations of coronary artery disease. An established use of drug coated balloon is for in-stent restenosis of both bare metal and drug eluting stents [1]. Drug coated balloon transfers antiproliferative drugs into the vessel wall during single balloon inflation. This is done by means of a lipophilic matrix. The advantage over drug eluting stent is that there is no permanent implant. Drug eluting stents have the disadvantages of neo-atherosclerosis and stent thrombosis. Even temporary implants like bioresorbable scaffolds have elevated thrombotic risk.
Drug co...
Source: Cardiophile MD - November 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs
Alcohol Ablation of Vein of Marshall for Persistent Atrial Fibrillation
Highly diagrammatic representation of coronary veins
Vein of Marshall (VOM) is a tributary of the coronary sinus with abundant sympathetic and parasympathetic innervation. It has been implicated in the genesis and maintenance of atrial fibrillation (AF). Three reasons described are the myocardial extensions into the structure, node like remnants within the vein and the rich autonomic innervation surrounding it [1] It is anatomically related to the mitral isthmus. Mitral isthmus is the region between the left inferior pulmonary vein ostium and the mitral annulus. Oblique vein of Marshall is the residua of the embryonic l...
Source: Cardiophile MD - November 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
PEA cardiac arrest, ROSC, and no STEMI on ECG. Randomized trials say emergent reperfusion is not indicated, right?
This study had a fatal flaw: they did not keep track of all the " Non-STEMI patients " who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients whom they suspected had Occlusion MI (OMI), even if they did not have STEMI. These physicians did not want a patient with an OMI that was not a STEMI to be randomized to no angiogram. This strong suspicion is supported by their data: only 22 o...
Source: Dr. Smith's ECG Blog - November 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
