SVG (saphenous vein graft) to obtuse marginal (OM) branch
Coronary angiogram in a post coronary artery bypass (CABG) person. Sternal wires indicate that post CABG status. Catheter tip can be seen engaged in the ostium of the saphenous vein graft (SVG) in the ascending aorta. Part of the catheter in the descending aorto is also visible as it is a trans femoral coronary angiogram. SVG graft is nicely visualized through its whole length up to its anastamosis on to the obtuse marginal (OM) branch of left circuflex coronary artery. Faint retrograde filling into the proximal part of OM is visible as well as good filling into the distal branches. (Source: Cardiophile MD)
Source: Cardiophile MD - November 13, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology Source Type: blogs
Bridging collaterals
are a feature of chronic total coronary occlusions (CTO). They bridge between the proximal and distal parts of a coronary artery which is chronically occluded in between. Presence of bridging collaterals, though physiologically useful for providing distal perfusion, could create problem during attempted percutaneous coronary intervention (PCI). A guidewire passed from the proximal segment, instead of passing into the occluded segment, is likely to take the easy way out into the bridging collaterals.
The coronary angiogram shows bridging collaterals in a post coronary artery bypass right coronary CTO. Sternal wires indica...
Source: Cardiophile MD - November 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology Source Type: blogs
Underuse is Rampant, But Overuse is All We Talk About
By KIP SUILLIVAN, JD
This is my fourth in a series of imaginary lectures on remedial health policy for President Obama. My goal is to convince Obama that he relied on the wrong people for health policy advice. I am focusing on three people in particular: Elliott Fisher and his colleagues at the Dartmouth Institute, Peter Orszag, and Atul Gawande.
In my first comment , I criticized Obama for clinging to the belief that the Affordable Care Act has already reduced health care inflation and will continue to do so in the future. I devoted my second comment to explaining how influential the Dartmouth Institute has been. In my ...
Source: The Health Care Blog - October 6, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Five Lessons From 30 Years Of Bundled Payments
In recent years, large employers, physician groups, and commercial and governmental payers have been increasingly interested in the use of episode-based bundled payments as a mechanism to promote high-quality health care and smarter spending. A “bundled payment” occurs when a payer provides reimbursement to providers for a full range of care, rather than paying individual bills for parts of that care such as the surgery, physician fees, and post-acute care.
The Comprehensive Care for Joint Replacement model and the recently announced acute myocardial infarction and coronary artery bypass graft bundled payment programs ...
Source: Health Affairs Blog - October 3, 2016 Category: Health Management Authors: Alan L. Kaplan, Chad Ellimoottil and J. Thomas Rosenthal Tags: Costs and Spending Featured Organization and Delivery Payment Policy Alternative Payment Models Bundled Payments California Comprehensive Care for Joint Replacement model Source Type: blogs
LV aneurysm – left ventriculogram
Left ventricular aneurysm seen on left ventriculogram
This still picture from a left ventricular angiogram (left ventriculogram) shows a bulge in the anterolateral region of the left ventricle in systole suggestive of an aneurysm. A true aneurysm is composed of all three layers of the heart, namely endocardium, myocardium and pericardium. It has a wide neck and is very unlikely to rupture. In contrast, a pseudoaneurysm is a ventricular rupture sealed off by the pericardium. It has a narrow neck and has a high risk of secondary rupture. A true aneurysm can cause arrhythmias due to the viable tissue in the border zone with v...
Source: Cardiophile MD - September 19, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiac Surgery Source Type: blogs
Synthetic Cardiac Valves, Arteries, and Veins for Practicing Surgical Techniques
A recent publication in journal Cardiovascular Engineering and Technology describes the production and utilization of synthetic heart valves, arteries, and veins by surgeons and medical residents to practice and improve their cardiac bypass surgical skills, without the use of animal or human cadaver tissues. Researchers from the University of British Columbia used a polyvinyl alcohol hydrogel to create the synthetic tissue, which unlike animal and human tissues, does not decompose or become contaminated.
The treatment of arteries from animal or human cadavers with preservatives to prevent decomposition alters their texture...
Source: Medgadget - September 1, 2016 Category: Medical Equipment Authors: Iris Kulbatski Tags: Cardiac Surgery Thoracic Surgery Urology Vascular Surgery Source Type: blogs
An Unusual Tachycardia
This Case was sent by Atif Farooq and Scott Weingart, from Stony Brook.This is a 70-something with history of CABG who presented with 30 minutes of SOB and palpitations.Here is his ECG:What is it?Atif wrote this:" My first thought was perhaps a bidirectional V Tach, though the pt is not on digoxin and otherwise has no discernable reason to be in BVT. Scott was considering maybe an intermittent aberrant conduction, though we thought it odd for it to be strictly alternating beats.Here is my answer:Atif,Interesting EKG!I think it is SVT with every-other-beat-aberrancy. --Every QRS comes right on time, perfectly regu...
Source: Dr. Smith's ECG Blog - August 24, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
CMS Seeking Comment on Cardiac Care Model
The Centers for Medicare & Medicaid Services recently announced a new way to pay for the care of patients who have had a heart attack or need coronary artery bypass graft surgery. CMS is seeking comment on the five-year demonstration, which would take effect July 1, 2017, in 98 randomly selected metropolitan areas.
Overview
The demonstration plan works much like the Comprehensive Care for Joint Replacement (CJR) model implemented this year. Similar to CJR, the new bundling plan would reimburse providers a set amount for an entire episode of care, from admission to 90 days after the patient is discharged. Medicare wou...
Source: Policy and Medicine - August 22, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Prasugrel – Cardiology MCQ
Wrong statement about prasugrel:
a) Not influenced by CYP inhibitors
b) Higher bleeding risk in those with previous cerebrovascular events
c) Use in acute coronary syndrome is better restricted to the cathlab
d) Recommended in those above 75 years
Correct answer: d) Recommended in those above 75 years
Prasugrel has a higher bleeding risk in those above 75 years and in those with body weight less than 60 Kg. Prasugrel is not interfered with by CYP inhibitors, CYP2C19 gene variants or proton pump inhibitors, unlike clopidogrel. Rapid onset of action enables its use in the cathlab after coronary angiography if percutaneous i...
Source: Cardiophile MD - August 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 5
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Source: Cardiophile MD - August 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
August already!
I am posting this solely as reference notes. I forget with day-to-day life that I still need to keep track of changes.I have been studying post CABG (open heart surgery) cognitive dysfunction (aka pump head). It is an interesting topic. My dad had 5 bypasses done when he was 45 years old and I'm pretty sure he had this. About 10 years after his surgery, he tore down a perfectly good house. He lived 17 years after his surgery, which, at that time, was considered a pretty good track record.Hubby is now 6 years post CABG. I see signs of "stupid" decisions. His brother wanted his parents hous...
Source: Wife of a Diabetic - August 3, 2016 Category: Endocrinology Source Type: blogs
Hospitals Pivot to Post Acute Cardiac Care Under Bundled Payment System
It will not be news to any reader ofLab Soft News that our healthcare system is highly fragmented and often provides inadequate continuity of care. CMS is trying to help solve this problem, at least for post-acute cardiac care patients (see:Hospitals will pivot to post-acute care to thrive under cardiac bundles). This new initiative was detailed in a recent article, an excerpt from which is provided below:In the days and months after a heart attack, a patient has a long list of tasks to remember as they recover: Take medications, eat nutritious foods, go to physical therapy, to name just a few. This...
Source: Lab Soft News - August 2, 2016 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Health Insurance Healthcare Delivery Preventive Medicine Public Health Informatics Quality of Care Source Type: blogs
Eminence Based Medicine And Cardiac Surgery
Did a top surgeon perform a nonrandomized, semi-prospective, historically controlled clinical trial without IRB approval or patient consent? I don’t want to only pick on interventional cardiologists. Last week I wrote about a breathtaking case of interventional cardiology hubris. In response a prominent interventional cardiologist shared with me a fascinating anecdote about cardiac surgery. Here’s...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - July 26, 2016 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics CABG clinical trials Informed consent IRB minimally invasive Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 4
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Source: Cardiophile MD - July 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Dyspnea and Convex ST elevation, Marked LVH, with Bedside Echos
Case 1.Chief complaint: A 60-something African American male with 5 days of increasing SOB with dyspnea on exertion.This male in his 60's has a PMH of CAD with MI and CABG, HTN with LVH, hyperlipidemia, and mild HF with only moderately reduced ejection fraction (and some diastolic dysfunction as well).He presents with 5 days of worsening shortness of breath with orthopnea as well as chest pain. His BP is 191/90. He also has a history of venous thromboembolism and has not been taking his anticoagulants. He was also off of his BP meds (lisinopril, amlodipine and carvedilol).Here is his ED ECG (ECG #1):...
Source: Dr. Smith's ECG Blog - July 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
