Why is Aspirin, everyone ’ s nemesis ?
Here is a current review on a topic, which needs some soulful Introspection
For a kid, A stands for apple in kindergarten, while in the school of cardiac sciences, A would sound as Aspirin. Such is the importance of this drug, known for its obedient, predictable efficiency in the entire spectrum of CAD right from primary prevention of CAD to emergent primary angioplasty in Cath lab. Most of us will also agree, It is a work horse drug for not only for the cardiologists , but been an anchor drug in as many critical medical therapeutics, wherever platelets are to be passivated.
We are well aware of molecular bas...
Source: Dr.S.Venkatesan MD - February 1, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha guidelines aspirin bias-against-aspirin dapt esc guidelines mapt Source Type: blogs
Acute chest pain in a patient with LVH and known coronary disease. What does the ECG show?
A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain.Here is his ED ECG:What do you think?There is a flat and downsloping ST segment in V2 and V3. This could be due to posterior OMI. Is there an old ECG for comparison?Here is the most recent previous ECG:Indeed, there was some normal ST elevation in V2 and V3, discordant to a relatively deep S-wave which could be due to some LVH.Here is another previous ECG:So it looks like a posterior OMI.2 years prior he had an angiogram which showed 90% proximal stenosis of the circumflex. It...
Source: Dr. Smith's ECG Blog - January 25, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Three normal high sensitivity troponins over 4 hours with a " normal ECG "
Written byWilly FrickA 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of " chest burning. " The documentation does not describe any additional details of the history. The following ECG was obtained.ECG 1What do you think?The ECG shows sinus bradycardia but is otherwise normal. There is TWI in lead III, but this can be seen in normal ECGs. No labs were obtained. The patient was given a prescription for albuterol and a referral to cardiology.Smith comment:No patient over 25 years of age with unexplained chest burning should be discharged without a troponin rule out, no matt...
Source: Dr. Smith's ECG Blog - January 5, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
Essential haematology for cardiologist
Forget NEJM, Circulation, JACC, for some time. Hope & wish every one of us is aware of a journal called Blood, bringing stunning and dramatic discoveries week after week ,about the most crucial fluid that sustains our life. The journal Blood is published by the American Society of Haematology since 1949. Its impact factor is currently 20.8, celebrating its 75th year of existence .
We know, heart disease consistently tops the global mortality and morbidity charts . Without blood, heart is just a purposeless organ with four empty chambers. More than ninety percent of the cardiac mortality happens due to freezing an...
Source: Dr.S.Venkatesan MD - November 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 4 factor prothrombin complex concentrate 4 factor prothrombin complex concentrate. 4F-PCC : dilute thrombin time andexanet alfa anticoagulants bleeding risk Chromogenic anti-Xa assay dabigatron dapt doacs dTT: dilute Source Type: blogs
Essential hematology for cardiologist
Forget NEJM, Circulation, JACC, for some time. Hope & wish every one of us is aware of a journal called Blood, bringing stunning and dramatic discoveries week after week ,about the most crucial fluid that sustains our life. The journal Blood is published by the American Society of Hematology since 1949. Its impact factor is currently 20.8, celebrating its 75th year of existence .
We know, heart disease consistently tops the global mortality and morbidity charts . Without blood, heart is just a purposeless organ with four empty chambers. More than ninety percent of the cardiac mortality happens due to freezing and...
Source: Dr.S.Venkatesan MD - November 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 4 factor prothrombin complex concentrate 4 factor prothrombin complex concentrate. 4F-PCC : dilute thrombin time andexanet alfa anticoagulants bleeding risk Chromogenic anti-Xa assay dabigatron dapt doacs dTT: dilute Source Type: blogs
Chest pain and anterior ST depression. What ’s the cause(s)?
Written by Jesse McLaren, with edits from Smith and GrauerA 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. What do you think? I sent this to Dr. Meyers without any other information, and he responded, “do you have a prior to make sure that it is all just because of the delta wave? Would be careful to make sure it’s not inferoposterior OMI superimposed on baseline WPW.” In other words, when there are ST/T wave changes thefirst question is whether there ’s abnormal depolarization, because this will be followed by abnormal ...
Source: Dr. Smith's ECG Blog - October 13, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A man in his 60s with chest pain and LBBB
Sent by Ali Khan MD, written by Pendell MeyersA man in his 60s with HTN, HLD, known prior LBBB, presented with episodes of chest pain radiating to the left shoulder, with diaphoresis and dyspnea. Episodes started yesterday after starting to exercise, came and went throughout the day, and he decided to present to the ED the next morning after the one of these episodes failed to resolve like the others.Here is his ECG at triage with ongoing pain (prior unavailable):Same image optimized by PM Cardio appWhat do you think?I sent this to Drs. Smith, McLaren, and Grauer all of whom immediately diagnosed LAD occlusion based ...
Source: Dr. Smith's ECG Blog - September 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell 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
D-Cube syndrome : DES-Dengue-DAPT
Background
A 52-year-old diabetic woman who had undergone recent PCI with a DES developed a febrile illness which was diagnosed as Dengue fever. She has been taking DAPT (Dual antiplatelet) meticulously to maintain her stent. Now, her platelet count has dropped from 1.5 and subsequently to 1 lakh. She is asking now, whether to stop DAPT or not? What is the risk of stent occlusion if she stops?
The D³ cube syndrome
Infectious diseases rarely bother a cardiologist (maybe a few IE, myocarditis, etc). Now, a unique situation is emerging.
*Dengue affects 50-100 million people worldwide every year and one billion are ...
Source: Dr.S.Venkatesan MD - September 9, 2021 Category: Cardiology Authors: dr s venkatesan Tags: anti platelet drug antiplatelet drugs in dengue clopidogrel prasugrel ticagrelol in dengue fever dapt in dengue fever therapeutic issues in dengue and cad warfarin heparin in dengue Source Type: blogs
Pancreatitis with Bizarre T-wave inversions and a normal echo. Is it takotsubo?
I was shown this ECG and told that the patient is suffering from another bout of chronic pancreatitis. I was told there was no chest discomfort or SOB. What do you think?I said " this looks like takotsubo " .With this ECG and the presumptive diagnosis of pancreatitis, takotsubo stress cardiomyopathy is by far most likely. It is possible that it is due to ACS, but thebizarre diffuse T-wave inversions with a very long QT are nearly pathognomonic of takotsubo. (They can also be seen in apical hypertrophic cardiomyopathy, but this patient did not have any such history and previous ECGs were different)If ...
Source: Dr. Smith's ECG Blog - July 31, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
HOST-EXAM trial
This study is definitely hypothesis generating and calls for a multi national, double blind comparison on a larger scale to get a better conclusion on long term antiplatelet monotherapy after PCI with DES.
AUGUSTUS trial
A somewhat similar disadvantage for aspirin was suggested in the AUGUSTUS trial among patients with atrial fibrillation and recent ACS or PCI [2]. Adding apixaban to P2Y12 inhibitor resulted in lower bleeding compared with vitamin K antagonist and a lower rate of death or rehospitalization. Addition of aspirin resulted in greater bleeding without any difference in efficacy. 92.6% of the patients...
Source: Cardiophile MD - June 15, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
ISAR-REACT 5 Trial – Review
ISAR-REACT 5 Trial – Review
ISAR-REACT 5 Trial [1] was a multicenter study with randomized patients who presented which acute coronary syndrome for whom an invasive strategy was planned, to either ticagrelor or prasugrel. It was an open label trial. Primary end point was a composite of death, myocardial infarction or stroke at one year. A major secondary safety endpoint was bleeding. This was an investigator-initiated trial funded by German Center for Cardiovascular Research and Deutsches Herzzentrum München (German Heart Center Munich).
4,018 patients were randomized in the study. Primary composite endpoint occurr...
Source: Cardiophile MD - April 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Federal Courts Shouldn ’t “Abstain” from Hearing Federal Civil Rights Claims
Ilya Shapiro andMallory ReaderHawaii sued Bristol ‐Myers Squibb (BMS) and Sanofi for failing to make the untrue statements that their life‐saving drug, Plavix, is less effective for Asian and Pacific Islander patients. It’s not just the companies that believe these statements to be false and controversial; the scientific community stron gly agrees. Prominent cardiologists have criticized the disclaimer requirement and a growing body of evidence shows that Plavix works as well, if not better, for patients of Asian descent.In seeking to compel this speech in an area of scientific controversy —and punish it...
Source: Cato-at-liberty - March 24, 2021 Category: American Health Authors: Ilya Shapiro, Mallory Reader Source Type: blogs
Saw this ECG while reading through a stack. Lots here: myocardial stunning, MRI viability, P2Y12 inhibitors and CABG.
I had just finished passing the shift off to my partner and the next shift of residents. It was 11:30 PM. I turned to the computer system to finish reading any EKGs from the shift and I saw this one, which had been recorded after the end of my shift at 11:11.Usually these are brought immediately by the tech to the faculty physician. I ' m not certain whether another faculty had seen this or not.What do you think?I immediately saw the ST depression in V2 and V3 of at least 1.5 mm. There is also minimal STD in II, III, aVF. When you see this inferior STD, you should not think " in...
Source: Dr. Smith's ECG Blog - February 26, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
