What are these wide complexes? If unclear by explanation, the laddergram helps to understand.
An 18 y.o. female who presented for chest pain. Patient reports productive cough and headache x 4 days. She notes persistent sternal chest pain worse at night and waking her from sleep. She also notes intermittent abdominal pain, describing as a " tightness " ." Sinus arrhythmia with variable right bundle origin PVCs "Is this accurate?No.This is sinus bradycardia with a slightly accelerated right ventricular escape, such that sometimes:1. the sinus beat is conducted before any ventricular escape (beats 7)2. the ventricular beat starts at almost the exact same time as the P-wave, and the P-wave therefore does no...
Source: Dr. Smith's ECG Blog - February 19, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
National Vascular Registry: 2019 annual report
Royal College of Surgeons of England - This is the seventh annual report since the National Vascular Registry was launched in 2013. It contains comparative information on five major interventions for vascular disease: lower limb bypass; lower limb angioplasty/stenting; major lower limb amputation; carotid endarterectomy; and repair of aortic aneurysms, including elective infra-renal, ruptured infra-renal, and more complex aneurysms.ReportMore detail (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - December 15, 2019 Category: UK Health Authors: The King ' s Fund Information & Knowledge Service Tags: NHS finances and productivity NHS measurement and performance Source Type: blogs
An excerpt from the Revised & Expanded Edition of Wheat Belly
The original Wheat Belly book rocked the nutritional world with its revolutionary ideas. But, as time has passed, I’ve added new strategies and concepts that have expanded the overall program and taken the health, weight, and youth-preserving benefits even further. I have therefore collected all this new material into a new Revised & Expanded Edition. The new Revised & Expanded Edition of Wheat Belly is now available at all major bookstores.
Here is a brief excerpt from the new foreword:
Wheat Belly began as my modest effort to help people with heart disease stop relying on the revolving door of angiop...
Source: Wheat Belly Blog - December 14, 2019 Category: Cardiology Authors: Dr. Davis Tags: Open autoimmune blood sugar bowel flora cholesterol diabetes Dr. Davis Gliadin gluten-free grain-free grains Inflammation low-carb microbiota prebiotic probiotic wheat belly Source Type: blogs
Interview with Medtronic ’s Mark Pacyna on Approval of IN.PACT AV DCB for Failing AV Fistulae
End-stage renal disease (ESRD) patients experiencing kidney failure typically require hemodialysis in order to artificially remove fluid and waste from blood and maintain appropriate electrolyte concentrations. For many patients on hemodialysis, an arteriovenous (AV) fistula is created to link an artery to a vein. Veins are too fragile for frequent access, but arteries are too deep. Creating an AV fistula makes the vein that is linked to an artery more resilient and capable of providing regular vascular access for dialysis.
While effective, and a standard of care for ESRD patients, vessel restenosis can occur over time ...
Source: Medgadget - December 5, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Exclusive Medicine Vascular Surgery Source Type: blogs
IN.PACT AV Drug Coated Balloon for Dialysis Patients to Heal AV Fistulaes
Medtronic has won FDA approval to introduce its IN.PACT AV drug-coated balloon as a treatment option for failing arteriovenous (AV) fistulae.
People with non-functional kidneys who undergo dialysis receive AV fistulae, which link an artery to a vein. Veins tend to be too fragile for regular access, but arteries are too deep. Creating an AV fistula makes the connected vein much more resilient and capable of providing vascular access for dialysis.
Eventually, AV fistulae tend to fail because of restenosis, limiting blood flow, and have to be expanded. This is a frequent procedure that comes with dangers, costs, and dis...
Source: Medgadget - November 25, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Medicine Vascular Surgery Source Type: blogs
How common is the progression of non-culprit lesion after PTCA ? What is the significance?
Whenever a patient is getting discharged after a PCI, the treating cardiologist often faces this situation.
So, you fixed the block in my coronary artery doctor. Thank you so much. Now, I can have a peaceful life, free from future heart problems. “Am I right doctor”?
I wish I can answer “Yes” to your query but I can’t for the following reasons.
I have fixed only a lesion that caused maximum obstruction. Atherosclerosis is a diffuse disease and you have minor plaques scattered across your coronary artery. These can grow at its own will. So you carry a definite risk remote from the current ...
Source: Dr.S.Venkatesan MD - November 24, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized COURAGE ORBITA ISCHEMIA post ptca care progression of native vessel disease after ptca Source Type: blogs
A man in his 30s with chest pain
Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" Initial...
Source: Dr. Smith's ECG Blog - November 19, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 30s with 12 hours of chest pain; is the ECG consistent with 12 hours of occlusion?
Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" Initial...
Source: Dr. Smith's ECG Blog - November 19, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Forbidden tips in PTCA : OMG , give me strength to leave this lesion alone !
Confabulation of a confused cardiologist
Yes, It has never bothered me to retrogradely cross a delicately dangerous epicardial collateral in complex CTO. Delivering a twin stent in a partial culotte strategy for a bifurc lesion has never tested my talents. Stenting a left main across the LAD, jailing the LCX with OCT support is my favorite time pass. Crushing a calcium infested diffuse long lesion with diamond-tipped ablator appear as breezy as shopping in a mall.
Oh …I am terribly upset with this damn thing.
What is that?
It requires 4 negative forces . . . to bring one big positive Impact!
These studies say medic...
Source: Dr.S.Venkatesan MD - November 17, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome acc esc guidelines scai pci ptca stable chd courage bari 2d orbita ischemia trials tips and tricks in ptca Source Type: blogs
Confabulation of a cardiologist – post ISCHEMIA trial !
I have never found it difficult to retrogradely cross a dangerous epicardial collateral in complex CTO. Delivering a twin stent in a partial culotte strategy for a bifurc lesion has never tested my talents. Stenting a left main across the LAD, jailing the LCX with OCT support is my favorite time pass. Crushing a calcium infested diffuse long lesion with diamond-tipped ablator appear as breezy as shopping in a mall.
But this one is really challenging
What is that?
Understanding these four studies (Ref 1-4 ). They dogmatically say medical management confers definitive protection in chronic coronary syndromes. It stretches...
Source: Dr.S.Venkatesan MD - November 17, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome acc esc guidelines scai pci ptca stable chd courage bari 2d orbita ischemia trials tips and tricks in ptca Source Type: blogs
Prolonged balloon inflation time : Surprise , why few takers for this PTCA concept?
I asked some of my experienced colleagues, how much time they inflate the balloon to deliver a stent? Most answers were spontaneous and unanimous “It’s hardly 10 seconds, few said maybe up to 15s.
Can prolonged balloon inflation time reduce the need for post dilatation and prevent mal-apposition?
We know high-pressure Inflation( up to 20 atmospheres ) was a big revelation in the science of PTCA more than two decades ago. (Antonio Colombo JACC 1995 ) He proposed and proved high-pressure inflation eliminated the need for routine anticoagulation following stenting as approximation was better. He also pioneere...
Source: Dr.S.Venkatesan MD - November 1, 2019 Category: Cardiology Authors: dr s venkatesan Tags: post dilatation Tips and tricks in cath lab Uncategorized balloon inflation time in ptca how to avoid post dilatation malapposition and balloon inflation time tips and tricks in ptca Source Type: blogs
40-something male in a head-on Motor Vehicle Collision and Splenic Injury
A 40-something male presents to the stabilization room for evaluation following head on motor vehicle collision (MVC). Pt was reported restrained driver, hit at city speeds, with + airbag deployment.The MVC was unquestionably caused by the other car, not by this driver.The patient complained to EMS of chest pain and a prehospital EKG en route was concerning for STEMI.The patient was at all times hemodynamically stable, without evidence of any profuse bleeding.He had an ECG recorded on arrival to the ED:Anterior and Inferior STEMI with diffuse hyperacute T-waves. This ECG really can ' t be anything else.&nb...
Source: Dr. Smith's ECG Blog - October 26, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A young peripartum woman with Chest Pain
This is written by Brooks Walsh.https://twitter.com/BrooksWalshA 30 year-old woman was brought to the ED with chest pain.It had started just after nursing her newborn, about an hour prior, and she described it as a severe non-pleuritic “pressure” radiating to the back.She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying " I ' m just an anxious person. "A CXR and a CTA for PE were normal.The ECGsAn initial ECG was obtained as the pain was rapidly resolving:Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and&nbs...
Source: Dr. Smith's ECG Blog - October 23, 2019 Category: Cardiology Authors: Brooks Walsh Source Type: blogs
60-something with 2 days of intermittent epigastric pain. Why does the cardiologist disagree?
Conclusion An invasive strategy based on coronary stenting with adjunctive use of abciximab reduces infarct size in patients with acute STEMI without persistent symptoms presenting 12 to 48 hours after symptom onset.===================================MY Comment by KEN GRAUER, MD (10/20/2019):===================================I find it difficult to believe that the Cardiologist Attending On Call did not allow for the possibility that the OMI in this case was either acute and/or ongoing.MY Question: Was this the opinion of the Attending Cardiologist — or a Resid...
Source: Dr. Smith's ECG Blog - October 19, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
How are hospitals supposed to reduce readmissions? Part III
By KIP SULLIVAN, JD
The
Medicare Payment Advisory Commission (MedPAC) and other proponents of the
Hospital Readmissions Reduction Program (HRRP) justified their support for the
HRRP with the claim that research had already demonstrated how hospitals could
reduce readmissions for all Medicare fee-for-service patients, not just
for groups of carefully selected patients. In this three-part series, I am
reviewing the evidence for that claim.
We saw in Part I and Part II that the research MedPAC cited in its 2007 report to Congress (the report Congress relied on in authorizing the HRRP) contained no studies supporting tha...
Source: The Health Care Blog - October 14, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Medicare health reform Hospital Readmissions Reduction Program HRRP Kip Sullivan MedPAC Source Type: blogs
