" Pay me now, or pay me later "
This patient presented with acute pulmonary edema without chest pain.A bit of history prior to showing the ECG:The patient had been hospitalized at a different hospital for pneumonia and NonSTEMI for a week. The troponin I had peaked at 40 ng/mL, and echo showed multiple wall motion abnormalities and EF of 35%. The patient suffered third degree heart block with bradycardia and required permanent pacemaker placement. A troponin that high is usually associated with Occlusion.I reviewed the ECGs from that hospital and they donot show OMI. But many ECGs in patients with OMI do not reveal the OMI, even when I ...
Source: Dr. Smith's ECG Blog - December 10, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Will PCI reverse LV dysfunction in Ischemic cardiomyopathy ?
PCI is effective in relieving angina, what does it do to LV dysfunction?
This is a fundamental query in the principles of revascularisation of CAD . The term LV dysfunction can convey a bizarre meaning.It can constitute any of the combinations of the following.Cell death, necrosis, scarring, fully dead, partially dead, partially viable, apoptotic cells that are clustered across various myocardial segments. These cells are interwoven with fibrotic interstitium. Microvascular integrity is also altered.
Cells stretch, slip and slide with one another. Contractile architecture is lost. This is referred to as remodeling.In the...
Source: Dr.S.Venkatesan MD - December 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: CABG for Ischemic DCM Dilated cardiomyopathy Uncategorized How effective is pci in reversing lv dysfunction ? REHEAT STICH CABG PCI MEDICAL THERAPY revascularisation in ischemic dcm Source Type: blogs
DAPT blues in ACS : Does Prasugrel really bother to know about the coronary anatomy before it acts ?
It appears,antiplatelet agents are waging a turf war on the CAD battlefield. It is no secret either, the fight often goes beyond academic reasons. Though NSTEMI connotes a true cardiac emergency, it consists of a highly heterogeneous population. A patient with UA can be treated even at home (Low-grade angina with little ECG changes, when it’s due to Increase demand situation). While, in the other extreme of NSTEMI, a patient with a GRACE score >200, in Ischemic LVF, might need an emergency multivessel angioplasty along with Mitra clip ± ECMO support.
Antiplatelet agents along with heparin will re...
Source: Dr.S.Venkatesan MD - October 19, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome oral anticoagulants warfarin acitrom prasugrel 2b3a vs prasugrel coronary anatomy in nsteacs dapt mapt NSTEMI guidelines esc acc 2020 prasugrel vs aspirin vs ticagrelor reopro vs prasugrel themis twilight study Source Type: blogs
New Technologies Drive Cost Growth Over Time
By KEN TERRY
(This is the eighth and final installment in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Medical technologies include drugs, devices, tests, and procedures. Considered as a whole, these technologies are the key driver of growth in health costs, according to Georgetown University professor Gregg Bloche and his associates.
Bloche, et al., view insurance coverage as the chief enabler of these technological innovations. In a 2017 Health Affairs Blog post, they said, ...
Source: The Health Care Blog - October 5, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Ken Terry Source Type: blogs
de Winter syndrome
de Winter syndrome was initially described as a new ECG sign of occlusion of proximal left anterior descending (LAD) coronary artery by Robbert J de Winter, Niels J W Verouden, Hein J J Wellens and Arthur A M Wilde, Interventional Cardiology Group of the Academic Medical Center, in 2008 as a Letter to the Editor [1]. Instead of the ST segment elevation which is typical of anterior wall infarction which occurs in total occlusion of LAD, they described anterior ST segment depression, in about 2% of cases.
An ECG with typical features showing upsloping ST segment depression in anterior leads with tall symmetric T waves and l...
Source: Cardiophile MD - September 7, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology de Winter sign LAD total occlusion Source Type: blogs
A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia
Discussion:The management in this case is unfortunately common practice at many places around the world where we receive cases. Why would an interventionalist violate multiple recommendations from their own guidelines and watch at 10am while an LAD occlusion plays out in front of them? What could explain why some providers do not seem interested in the fact that LAD occlusion can be identified by something other than STEMI criteria? Or why the wall motion abnormality matching the distribution of concern is ignored? The only plausible explanation is that they have been taught that this is standard practice. Under the STEMI ...
Source: Dr. Smith's ECG Blog - August 23, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Antegrade dissection and re-entry for chronic total occlusions
Antegrade dissection and re-entry for chronic total occlusions: Opening up of chronic total occlusions (generally more than 3 months old) is always challenging. While attempting to wire a chronic total occlusion (CTO), the wire can go subintimally and then renter the true lumen distally. Unless there is guidance with intravascular ultrasound (IVUS) or optical coherence tomography (OCT), it is almost a blind try.
In the technique known as sub-intimal tracking and re-entry (STAR) technique, a knuckled wire was passed [1]. But this produced an uncontrolled re-entry, sometimes very distally near a bifurcation. Stenting then w...
Source: Cardiophile MD - June 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
Planned PCI in high bleeding risk patient: Three forbidden options
Though two stents Onyx one (Medtronic) and Biofreedom(Biosensors) appear promising with rapid endothelisation and hence short DAPT. There are three more options. available in this situation.
Option 1
Avoid the endothelium unfriendly DES and use BMS* and use MAPT (Mono or minimal antiplatelet therapy). For the sake of the young generation cardiologists, let me expand BMS,ie Bare metal stents.
BMS in 2020 ! What nonsense are you talking about? (For those who ask this question, please try to go through the following study with a conscience)
(NORSTENT 2016 -One of the most underrated, deliberately concealed landmark paper in...
Source: Dr.S.Venkatesan MD - June 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized biofreedom vs onyxone bms for high bleeding risk BMS VS DES IN 2020 NORSTENT BASKET PROVE NEJM POBA DEB to reduce bleeding risk Source Type: blogs
Are there benefits of cardiac catheterization for stable coronary artery disease?
One of the main causes of chest pain is a blockage of blood flow down the coronary arteries, the blood vessels that deliver oxygenated blood to our heart muscle to allow it to beat. Depending on how fast the blockage forms, it is labeled as either a stable or unstable blockage.
Unstable blockages occur quickly when an atherosclerotic plaque ruptures within the coronary artery and a clot forms on top of it. The clot, along with the plaque, can obstruct blood flow, deprive heart muscle of oxygen, and lead to a heart attack. This is called an acute coronary syndrome, and it frequently requires a minimally invasive procedure c...
Source: Harvard Health Blog - May 21, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Tests and procedures Source Type: blogs
Supersaturated Oxygen Therapy Cleared in EU to Treat Widowmaker Heart Attacks
ZOLL Medical, a part of the Asahi Kasei Group, won EU clearance for its SuperSaturated Oxygen (SSO2) Therapy System to be used to minimize the damage that heart attacks cause within heart muscle.
Approved about a year ago in the United States, SSO2 is the only option beyond percutaneous coronary intervention (stenting) that can help stricken patients recover with improved outcomes.
These days, heart attacks are usually treated by placing stents at the sites of narrowing coronary arteries. This has become a standard of care and interventional cardiologists can accurately place stents within minutes. Although blood f...
Source: Medgadget - May 6, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Source Type: blogs
Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?
This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates.
A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms ...
Source: Harvard Health Blog - April 27, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Surgery Source Type: blogs
Radiation induced coronary artery disease – RICAD
Radiation induced coronary artery disease – RICAD
Radiation induced coronary artery disease (RICAD) is an important long term sequelae of radiotherapy to the chest region. The most common conditions associated with RICAD are breast cancer and Hodgkin’s lymphoma. The risk is higher in Hodgkin’s lymphoma because they receive a higher dose of radiotherapy [1]. It may be noted that radiation is used in the treatment of about 50% of cancers [2]. Hence the importance of RICAD.
Radiation causes vascular endothelial injury. It initiates and accelerates atherosclerosis. Proinflammatory cytokines were increased in ...
Source: Cardiophile MD - April 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Onco Cardiology Source Type: blogs
Next-Gen TherOx SuperSaturated Oxygen Delivery System FDA Approved
ZOLL Medical, now a part of Asahi Kasei Group, won FDA approval for the latest version of its TherOx System. The product is designed to deliver SuperSaturated Oxygen (SSO2) therapy to limit heart muscle loss following “widowmaker” heart attacks, aka left anterior descending ST-elevation myocardial infarction (LAD STEMI) chronic total obstruction.
The system is used right after blood flow is restored during angioplasty and stent implantation to pump hyperbaric levels of oxygen straight into injured cardiac tissue. It’s important that this happens within six hours of the onset of symptoms.
“SSO2 Therap...
Source: Medgadget - April 1, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Emergency Medicine Radiology Source Type: blogs
Stress echocardiography – MCQ – Answer
Stress echocardiography – MCQ – Answer
Stress echocardiography is useful when – Correct answer: d) All of the above
Hibernating myocardium is viable myocardium Low dose dobutamine infusion improves the contraction of hibernating myocardial segments which are chronically ischemic. Such patients may benefit from revascularization procedures like coronary artery bypass grafting or percutaneous coronary intervention.
Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
Early ECG change in transmural MI – MCQ – Answer
Early ECG change in transmural MI – MCQ – Answer
Early ECG change in transmural myocardial infarction – Correct answer: b) ST elevation in the leads facing the infarct
ST Elevation Myocardial Infarction (STEMI) is usually due to total occlusion of a major coronary artery. Best form of initial treatment if primary angioplasty. If it is not logistically feasible, next best option is thrombolysis.
Q waves appear later on when there is transmural necrosis and myocardium in the region acts as an electrical window reflecting negative waves due to depolarization of the opposite viable wall of the ventricle.
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Source: Cardiophile MD - March 28, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
