Cardiac Catheterisation Laboratory
Cardiac catheterisation laboratory – place where angiography and inteventions are done
Cardiac catheterisation laboratory is the place where angiography (imaging of blood vessels and the heart) and interventions are done. It is akin to the theatre for surgical procedures and has to be maintained in a sterile (free of micro organisms causing infection). Cardiac catheterisation laboratory (cathlab) is a comprehensive setup used for diagnostic and therapeutic (treatment) cardiac catheterisation. Cardiac catheterisation is the process in which small tubes are introduced into various chambers of the heart under local anesthes...
Source: Cardiophile MD - May 1, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Source Type: blogs
Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?
A middle-aged male had a V Fib arrest. He had not complained of any premonitory symptoms (which is very common). He had a history of CAD with CABG. Here was his initial ED ECG:There is atrial fibrillation with a rapid ventricular response. There is profound ST depression especially in I, II, V2-V6.ST depression is common BOTH after resuscitation from cardiac arrest and during atrial fib with RVR.The patient was cardioverted. Here is the post cardioversion ECG:ST depression, with ST elevation in aVR persists.Does this patient have ACS? Should he necessarily go to the cath lab?Again, it i...
Source: Dr. Smith's ECG Blog - April 24, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
From Scott Weingart EMCrit Interview: Who needs the Cath Lab now??
Who Needs the Cath Lab/Cards Consult?Here is the podcast of Scott's Interview with me . (some of this gets distorted in MS internet explorer)FirstActivate the Lab for unambiguous STEMI (only clear STEMIs have a 90 minute CMS mandate)Get Cardiology or Interventional Consultation for more complicated cases: difficult ECGs, subtle ST elevation, ST depression with ongoing symptoms, STEMI "Equivalents.This requires a systematic approach, with buy-in from Cardiology, that they will respond immmediately to such requests for help. What do they get out of it? Fewer false positive activations and more activatio...
Source: Dr. Smith's ECG Blog - March 29, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Ignorance, Knowledge, and Bliss; Not Always Obvious
I’ve just finished sitting through a wonderfully aptly named lecture: Probability and Sadistics, in which, among other things, we learned (again) that the utility of various clinical tests depends at least as much and generally more on the patient and condition involved than on the specific test itself. From stress tests to mammograms to PSAs, the relationships of true and false positive and negatives, positive and negative predictive values all hinge on the prevalence of disease; or how likely is it that a given condition is present before you even do the test. Lots of times when you crunch those numbers, the best a...
Source: Musings of a Dinosaur - March 22, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Has CT Angiography Lived Up to Its Early Promise?
When it first appeared more than a decade ago computed tomographic angiography (CTA) astounded cardiologists and other physicians. Until it came along the only way to check for blockages in the vital coronary arteries that supply the heart itself with blood was with cardiac catheterization, an expensive, highly invasive and unpleasant procedure. In the following years CTA (the devices are manufactured by GE, Siemens, Toshiba, Philips and others) enjoyed an explosion of growth, fueled by enthusiasm for its ability to deliver speedy, high-resolution images of the coronary arteries. Many anticipated that CTA would prov...
Source: CardioBrief - March 14, 2015 Category: Cardiology Authors: Larry Husten Tags: Prevention, Epidemiology & Outcomes Chest pain CT angiography heart imaging NHLBI radiation Source Type: blogs
Study Uncovers Confusion About When To Use An Important Heart Test
Appropriate use criteria (AUC) are designed to help make sure that medical procedures and interventions are performed in people most likely to benefit and, in turn, are not performed in people unlikely to gain benefit. Now a new study published in Annals of Internal Medicine suggests that the AUC for one very widely performed procedure, diagnostic cardiac catheterization, can provide a very rough indication of when it should and should not be performed, but that a great deal more work needs to be done before the criteria can be considered broadly reliable. … Click here to read the full post More… (Source: CardioBrief)
Source: CardioBrief - March 9, 2015 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery Prevention, Epidemiology & Outcomes appropriate use criteria catheterization coronary artery disease diagnosis Source Type: blogs
Research and Reviews in the Fastlane 073
Welcome to the 73rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out ...
Source: Life in the Fast Lane - March 4, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education Emergency Medicine Neurosurgery Pre-hospital / Retrieval Resuscitation Trauma critical care examination Intensive Care R&R in the FASTLANE research and reviews Source Type: blogs
Mitral E/E’ ratio on echocardiogram
Brief Review
Abstract: Mitral inflow E/E’ ratio determined by Doppler echocardiogram is an important indicator of left ventricular diastolic function. It can be used in the presence of atrial fibrillation when E/A ratio is not available.
Mitral E/E’ ratio on Doppler echocardiography
Tissue Doppler echocardiography showing measurement of mitral E/E’ ratio for assessment of diastolic dysfunction. Initially mitral E wave is measured and stored as given in the image below. After that colour Tissue Doppler (tissue velocity imaging or TVI) mode is switched on to assess tissue Doppler. The cursor is placed over...
Source: Cardiophile MD - January 29, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs
Aortic stenosis gradient by Doppler echocardiogram
Inset shows apical five chamber view from which the aortic stenosis jet (AS Jet) is assessed using a continuous wave Doppler cursor. Aortic stenosis jet moves away from the transducer in this view and is displayed below the baseline. Velocity scale on the right side is in meters per second (m/s). Aortic regurgitation jet (AR Jet) is seen above the baseline as the regurgitant flow into the left ventricle is towards the transducer kept at the left ventricular apex. AV Vmax: maximum velocity of the aortic stenosis jet; AV V mean: mean velocity of the aortic stenosis jet; AV maxPG: maximum pressure gradient across the aortic ...
Source: Cardiophile MD - January 29, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs
FDA Approves New Heart Pump From Abiomed
Abiomed has announced that it received FDA approval for its Impella RP System, the first percutaneous single access heart pump that provides support to the right side of the heart. The approval, under a Humanitarian Device Exemption (HDE), is based on results of the single arm Recover Right study, in which 30 patients were enrolled. The overall survival rate was 73% at 30 days. … Click here to read the full post on Forbes. (Source: CardioBrief)
Source: CardioBrief - January 28, 2015 Category: Cardiology Authors: Larry Husten Tags: Heart Failure Interventional Cardiology & Surgery Policy & Ethics Abiomed catheterization Impella Source Type: blogs
Fighting the injustice of health disparities: Honoring the legacies of Dr. Martin Luther King Jr. & Dr. John M. Eisenberg
For the past several years I have run this post and just as it was those years, it is this year a very important message.
We, as a nation, have made progress and I believe Dr. King would be proud. But our work is far from complete – particularly where health care is concerned. Another doctor, Dr. John M. Eisenberg, a physician of tremendous stature whose life was also tragically cut short (not by an assassin’s bullet but by brain cancer) was equally passionate about the dignity of life and justice for all Americans. Dr. Eisenberg, who among other things, served as the Director of the Agency for Health Care Policy and R...
Source: Disruptive Women in Health Care - January 19, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Choice Source Type: blogs
Carabello sign
/ effect
Brief Review
Abstract: On LV (left ventricle) to aorta pull back, aortic pressure rises due to relief of the enhanced obstruction of the aortic orifice which had occurred while entering the LV in severe aortic stenosis. This is known as Carabello sign / effect.
Blase A. Carabello and colleagues described the Carabello effect as the change in arterial pressure when the catheter is pulled back from the left ventricle to aorta in severe aortic stenosis.1 When the catheter tip is in the left ventricle in severe aortic stenosis, usually with valve area less than half a square centimeter, the catheter itself enhanc...
Source: Cardiophile MD - January 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Carabello effect Carabello sign Carabello sign in severe AS severe aortic stenosis Source Type: blogs
Cardiac tamponade
Brief Review
Abstract: Cardiac tamponade is a life threatening situation in which fluid within the pericardial cavity compresses the heart preventing its filling during diastole.
Pericardial effusion is the collection of fluid between the parietal and visceral layers of the pericardium. Normally there could be a thin layer of fluid, about twenty to fifty milliliters, in the pericardial cavity. When fluid accumulates gradually in the pericardium due to a slow disease process, the parietal pericardium stretches to accommodate more fluid in the range of five hundred milliliters. But rapid collection of fluid as in the case...
Source: Cardiophile MD - December 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Shared Decision Making And The Use Of Patient Decision Aids
Discussion Paper and provide specific recommendations in three areas: technological support for shared decision making, recognition that failure of shared decision making comprises a medical error, and a transformation in how we conceptualize “informed consent.”
Patient Decision Aids and Shared Decision Making
The IOM Discussion Paper, on which we are coauthors, raises several interrelated issues that deserve further study. First, it recognizes that the policy environment increasingly supports the use of PDAs and standards of care support shared decision making, but these policies and ideals are not yet being translat...
Source: Health Affairs Blog - December 17, 2014 Category: Health Management Authors: Matthew Wynia, Benjamin Moulton, and Glyn Elwyn Tags: All Categories Health Care Delivery Health Reform Policy Quality Source Type: blogs
Becoming Highly Reliable: Changing Talk to Induce Transformation
By: Timothy J. Vogus, PhD, associate professor of management, Vanderbilt Owen Graduate School of Management
Dr. Vogus received his PhD in Management and Organizations from the University of Michigan. His research focuses on the cognitive (mindful organizing), cultural, motivational, and emotional processes through which individuals, workgroups, and organizations enact highly reliable performance. He explores these dynamics at the point of care delivery in health care organizations. His research has been published in top management and health services journals.
Dr. Souba’s recent article on the personal foundations o...
Source: Academic Medicine Blog - December 11, 2014 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective Communication high-reliability organizations mindful organizing personal transformation Source Type: blogs
