CABG and beta blockers – Cardiology MCQ
Perioperative use of beta blockers in CABG (coronary artery bypass grafting) is a:
a) Class I recommendation
b) Class IIa recommendation
c) Class IIb recommendation
d) Class III recommendation
Correct answer: a) Class I recommendation
As per the 2015 American Heart Association (AHA) guidelines on secondary prevention after CABG, all patients should be given beta blockers perioperatively to prevent post operative atrial fibrillation, ideally to be started before surgery, if there is no contraindication. It is a Class I recommendation with level of evidence A.
Reference
Kulik A et al. Secondary prevention after coronary art...
Source: Cardiophile MD - May 21, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: AV block after cardiac surgery
Complete AV block requiring permanent pacemaker implantation is more likely after:
a) Coronary artery bypass grafting
b) Aortic valve replacement
c) Mitral valve replacement
d) None of the above
Correct answer: b) Aortic valve replacement
Complete heart block can occur after aortic valve replacement as the conduction system is closely associated with the location of the aortic valve. Pre-existing extension of calcification from aortic valve to the conduction system can cause complete heart block. This can be accentuated by the pressure of the artificial valve on the conduction system. Injury to the conduction system can a...
Source: Cardiophile MD - May 15, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Factors determining the survival after coronary artery bypass surgery
The most important factor is the left ventricular function. Those with poor left ventricular function have poor survival. Left ventricular function can also deteriorate due to inadequate myocardial protection during surgery. The type of grafts used also has influence on the survival. Live arterial grafts like left internal mammary artery or dual internal mammary artery grafting give better long term results. Saphenous vein grafts in general give poorer long term results. But it may not be always feasible to harvest the left internal mammary artery in an emergency surgery, due to time constraints. Progression of native ve...
Source: Cardiophile MD - May 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery 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
Ventricular Fibrillation, Resuscitation, and Hyperacute T-waves: What does the Angiogram show?
An elderly person collapsed and was found to be pulseless. He had immediate bystander CPR. An AED was placed and one shock was given within 5 minutes of arrest. He immediately awoke. EMS arrived and recorded these ECGs:Time = 0Sinus rhythm. Inferior and lateral ST elevation, with hyperacute T-waves in V4-V6.1 min laterNo definite difference.He was stable en route to the ED. On arrival, he was awake and complained of only mild aching left chest pain. He stated that prior to his collapse, he had been walking briskly and was feeling short of breath, but not having any chest pain. He does ha...
Source: Dr. Smith's ECG Blog - April 19, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
What Can Patients Do In The Face Of Physician Conflict Of Interest?
Trust has always been essential to medical care. Of what use are the best communication skills, physician empathy, or clinical knowledge if patients don’t trust the advice and information that their doctors give them?
Even the most psychologically disturbed or misanthropic TV doctor—from Doc Martin to Gregory House—can always be trusted to put his patients first; this is precisely because this trustworthiness is so central to our understanding of being a physician. While this sort of idealization is commonplace and reassuring, it has become more and more problematic. For, in today’s medical world, the lines...
Source: Health Affairs Blog - April 10, 2015 Category: Health Management Authors: James Rickert Tags: All Categories Business of Health Care Consumers Health Care Costs Health Care Delivery Payment Personal Experience Physicians Policy Quality Source Type: blogs
How common is angina in Ischemic cardiomyopathy ?
We generally believe ischemia and it’s clinical counterpart angina would go together .It is not true .Most patients with ischemic cardiomyopathy do not have any significant angina in spite of having one or more critically narrowed coronary arteries.
The reasons could be many ,
Little viable tissue to generate Ischemia.
Less contractile elements and less MVO2 consumption.
Severe LV dysfunction makes these patients adopt a very restrictive lifestyle.
Loss of nerve fibers along with myocyte necrosis and apoptosis.
Post CABG patients often have no angina due to denervation..
The benefits of revascularisatio...
Source: Dr.S.Venkatesan MD - March 31, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Dilated cardiomyopathy angina in cardiomyopathy Ischemic dilated cardiomyopathy Source Type: blogs
Interesting Left Main Occlusion....
Many believe that left main occlusion results in diffuse ST depression with ST elevation in aVR. This is not true, as I write about in this post: The difference between left main occlusion and left main insufficiency. This patient presented with ischemic symptoms:There is diffuse ST depression, with ST elevation in aVR.This is consistent with coronary insufficiency, but not coronary occlusion.It could be a tight left main, or a tight LAD, especially with 3-vessel disease.Such patients have about a 50% chance of needing CABG, as shown in an article referenced and described in this post. Therefore, Plav...
Source: Dr. Smith's ECG Blog - February 25, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
My dad’s surgery helped bring me back to the art of medicine
In the midst of seeing a patient, I got a call from another physician, my dad’s new cardiologist.
“Looks like he is going to need CABG (open heart surgery) since he has four major blockages.”
I was expecting this call, and this result, based on his history of diabetes and at least one month of chest pain. It was still shocking to hear. I walked back into the exam to continue the visit with my own patient with diabetes, probably visibly shaken, so I shared the news with him. Would this medical disease so close to home change the care I provide for my patients? Yet to be determined, but now it was time to c...
Source: Kevin, M.D. - Medical Weblog - February 15, 2015 Category: Journals (General) Authors: Gregory Dodell, MD Tags: Physician Heart Surgery Source Type: blogs
Top stories in health and medicine, January 29, 2015
From MedPage Today:
U.S. Seniors Losing Grip on Muscle Strength. The first national survey on grip strength in older adults found that 5% of those over 60 had weak muscle strength, and 13% had intermediate strength.
Low MI Risk in Patients With Non-MI Chest Pain. Patients treated in emergency departments (EDs) for chest pain not related to MI have a very low short- and medium-term risk for having a heart attack, even if they do not receive noninvasive imaging tests to detect ischemia.
Transfusion Tied to Pneumonia After CABG. Patients who undergo coronary artery bypass graft surgery and require red blood cell transfusion...
Source: Kevin, M.D. - Medical Weblog - January 29, 2015 Category: Journals (General) Authors: MedPage Today Tags: News Endocrinology Geriatrics Heart Source Type: blogs
Academic Medical Centers Should Lead The Charge On Price Transparency
A bipartisan campaign to increase price transparency in the medical world has been reverberating through the press, government, and hospitals. Recent examples include CMS’ release of datasets for inpatient and outpatient charges and North Carolina’s House Bill 834, which was signed into law on August 21, 2013 and mandates that the state’s Department of Health and Human Services publish hospital charges. In Time Magazine, Steven Brill’s article, “Bitter Pill,” provided stunning real world examples of how the lack of price transparency can create enormous uncertainty and confusion among both patients and provider...
Source: Health Affairs Blog - January 21, 2015 Category: Health Management Authors: Giffin Daughtridge and Richard Shannon Tags: All Categories Consumers Health Care Costs Hospitals Payment Policy Quality Source Type: blogs
Reconsidering Pauly And Coauthors’ ‘Economic Framework For Preventive Care Advice’
In the November issue of Health Affairs, Mark Pauly and coauthors criticize the lack of cost-effectiveness considerations in the Affordable Care Act (ACA), which mandates that health plans include preventive care free at the point of use. The bodies critiqued, the Advisory Committee on Immunization Practices (ACIP) and the U.S. Preventive Services Task Force, convene health experts to develop recommendations for immunizations and other preventive services.
According to the authors, the task entrusted to these bodies by the ACA, of offering sound advice on preventive care without considering its cost-effectiveness, is “im...
Source: Health Affairs Blog - January 12, 2015 Category: Health Management Authors: Claudia Chaufan and Greg Harris Tags: All Categories Health Care Costs Policy Prevention Public Health Research Spending Source Type: blogs
Coronary angiography prior to surgery for valvular heart disease
Brief Review
Abstract: Coronary angiography prior to surgery for valvular heart disease is considered for those forty years and above if there are no coronary risk factors and for those thirty five years and above when there are coronary risk factors.
Screening coronary angiography is usual prior to surgery for valvular heart disease in older individuals even though most of these diagnostic angiograms turn out to be normal. This is done because clinical, electrocardiographic, echocardiographic and radionuclide are not very specific for detection of coronary artery disease in the presence of severe valvular heart diseas...
Source: Cardiophile MD - January 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiac Surgery Source Type: blogs
Arkansas Payment Improvement Initiative: Self-Insured Participation
Editor’s note: This post is part of a periodic Health Affairs Blog series, which will run over the next year, looking at payment and delivery reforms in Arkansas and Oregon. The posts will be based on evaluations of these reforms performed with the support of the Robert Wood Johnson Foundation. The authors of this post are part of the team evaluating the Arkansas model.
Designed and launched by the state’s Medicaid program and some of its largest private insurers, including Arkansas Blue Cross Blue Shield (BCBS) and QualChoice, the Arkansas Payment Improvement Initiative (APII) has been a multi-payer effort since its i...
Source: Health Affairs Blog - January 7, 2015 Category: Health Management Authors: Joseph W. Thompson, William Golden, Michael Motley, Mark Fendrick, Christopher Mathis, and Michael Chernew Tags: All Categories Employer-Sponsored Insurance Payment Policy States Source Type: blogs
Health Affairs’ January Issue: Aging And Health
The January issue of Health Affairs includes a number of studies examining issues pertaining to aging and health or health care. Other subjects covered include: the effect of Medicare’s Hospital Compare quality reports on hospital prices; how the Affordable Care Act’s provisions impact Americans shouldering high medical cost burdens; and whether California’s Hospital Fair Pricing Act has benefited uninsured patients.
Content on aging and health was supported by the John A. Hartford Foundation.
Has California’s Hospital Fair Pricing Act reduced the price actually paid by uninsured patients?
Ge Bai of the Williams Sc...
Source: Health Affairs Blog - January 5, 2015 Category: Health Management Authors: Chris Fleming Tags: Aging All Categories Health Care Costs Health Reform Hospitals Long-Term Care Medicaid Policy Quality States Source Type: blogs
