How to find which lesion is causing angina in multivessel CAD ?
Yes, it is a triple vessel disease, with one tight lesion and at least two other significant lesions. One of them appears diffuse as well.Â
Representative Image: Source courtesy DOI: 10.14740/cr548w LicenseCC BY-NC 4.0
“What to do next?. Is he symptomatic? Yes. Definitely has significant angina” but LV function is normal.
“Ok then. If you are daring enough, ask this question”.
Which lesion is causing angina?
No easy answer at all. Try looking for some clues right from history, ECG, stress ECHO, meticulous assessment of individual lesions. Realize, even sophisticated imaging l...
Source: Dr.S.Venkatesan MD - August 20, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Cardiology -Definitions cardiology- coronary care Ethics in Medicine Uncategorized ACC AHA ESC Guidelines for multivessel cad angina related artery ara vs ira approach to tvd cabg vs pci vs medical maangement ov cad Source Type: blogs
Cardiology Image watch : Its not a stent for sure … then what ?
A 75-year-old male post CABG with severe LV dysfunction and ICD and dual-chamber pacer in situ presented with NSTEMI.
An angiogram revealed something, and he got this form of treatment. ? What is it?
Image and case courtesy Patel R, Ghadiam H, Patel P, et al. (April 05, 2020) Angina Leading to Metal in the Heart: An Interesting Case of Saphenous Vein Graft Coiling. Cureus 12(4): e7546. doi:10.7759/cureus.7546
Features of SVG venous graft aneurysm
Graft aneurysm what are the risks?
Thrombosis
Recurrent ACS
RuptureÂ
ManagementÂ
Vascular plug
Multip...
Source: Dr.S.Venkatesan MD - July 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coil occlusion of coronary aneurysm post cabg coronary aneurysm SVG graft aneurysm Source Type: blogs
Cardiology MCQs
Modified Blalock-Taussig shunt is:
End to side anastomosis of subclavian artery to a pulmonary artery
Side to side anastomosis of main pulmonary artery to aorta
Side to side anastomosis of subclavian artery to a pulmonary artery using a conduit
Anastomosis of superior vena cava to right pulmonary artery
Correct answer: 3. Side to side anastomosis of subclavian artery to a pulmonary artery using a conduit
In classic Blalock-Taussig shunt, the subclavian artery is divided and anastomosed to the pulmonary artery as an end to side anastomosis. In modified Blalock – Taussig shunt, a Gore – Tex graft is used to connect th...
Source: Cardiophile MD - July 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Ischemic preconditioning
The concept of ischemic preconditioning is that multiple short episodes of ischemia can protect the heart from a later sustained ischemia later [1]. In an experimental study, 4 episodes of 5 minutes each, separated by 5 minutes of reperfusion followed by 40 minutes of occlusion showed 75% reduction in infarct size compared to controls. But this benefit was not there when the final occlusion time was 3 hours. Authors suggested that multiple pre-infarction anginal episodes may have a similar effect on limiting infarct size if myocardial infarction occurs subsequently. Others have suggested that similar mechanism might opera...
Source: Cardiophile MD - July 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Typical Chest Pain: Would you activate the cath lab? Would you advocate if the interventionalist was not interested?
A 50-something woman complained of acute chest pain radiating to the left arm, onset while driving. It would briefly improve with NTG.Here is the first ED ECG:What do you think?When I saw this, I immediately said: " This isAslanger ' s Pattern. " 1. Inferior OMI, with STE in lead III only, and reciprocal STD in aVL.2. Diffuse subendocardial ischemia (ST depression, STD, in I, II, V3-V6) with reciprocal STE in aVR.Aslanger ' s pattern is a combination of inferior OMI and diffuse subendocardial ischemia. The subendocardial ischemia produces an ST depression vector toward leads II and V5 (with reciprocal STE ...
Source: Dr. Smith's ECG Blog - May 10, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
PRAMI Trial – Review
PRAMI Trial – Review
Preventive Angioplasty in Myocardial Infarction Trial (PRAMI) was conducted at five centres in the United Kingdom between 2008 and 2013. The study enrolled 465 patients with acute ST elevation myocardial infarction (STEMI) including 3 with left bundle branch block. Patients undergoing infarct related artery or culprit artery percutaneous intervention were randomized to either preventive PCI or no preventive PCI [1]. After primary PCI, subsequent PCI was recommended only for refractory angina with objective evidence of myocardial ischemia. Primary outcome measure in the PRAMI trial was a composit...
Source: Cardiophile MD - April 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs
Coronary subclavian steal syndrome
Coronary subclavian steal syndrome is the diversion of blood from the coronary circulation to the exercising left upper limb after a coronary artery bypass graft (CABG) using left internal mammary artery [1]. This occurs when there is a high grade stenosis or occlusion of left subclavian artery proximal to the origin of the left internal mammary artery (LIMA). Though it is a rare phenomenon, it is a serious threat to the success of CABG.
Cardiovascular manifestation of coronary subclavian steal syndrome could be angina, myocardial infarction, malignant arrhythmias or heart failure [1]. Cerebral symptoms can occur due to ...
Source: Cardiophile MD - April 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Getting It Right Despite the Wrong Paradigm
Written by Alex Bracey, edits by Meyers and SmithA 50 something year old male presented to the ED as a transfer from an outside hospital with chest pain. As EMS gave report I looked through the transfer packet for the initial ECG:Sinus bradycardia with loss of R-wave progression and hyperacute T-waves in V2-V5, slight STE in aVL and I without meeting STEMI criteria. There is a down-up T-wave in lead III, which is a very specific reciprocal finding in high lateral OMI. Very highly suspicious of OMI. Applying the 4-variable formula for detection of subtle anterior OMI would yield: STE60V3 = 2.5, QTc = 360, RV4 = 3, QRSV2 = 5...
Source: Dr. Smith's ECG Blog - April 12, 2021 Category: Cardiology Authors: Bracey 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
Coronary collateral circulation : Why many scientific cardiologists Ignore it ?
A consult with a 62-year-old patient in my officeÂ
Hi, welcome? What is your problem?
Nothing doctor. I am good.Â
What brings you here then?
I used to have angina before. Now, I am fine doctor but confused after undergoing this angiogram. I need an opinion.
How is your exercise capacity?
I do walk, work, and able to do almost all regular activities.
Why did you do this angiogram then?Â
Had to undergo this after a doubtful stress test, Now, I am told by at least 2 eminent cardiologists, that I am having just one functional coronary artery, and it is dangerous for the all-important LAD to live at the merc...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized chronic total occlusion collateral circualtion in cto coronary collateral circulation interventions in cto Source Type: blogs
Need surgery? Should you avoid your surgeon ’s birthday?
If you need surgery, it should reassure you to know that researchers have been studying factors that predict surgical success or failure for years. Some of the most important findings have been ones you might expect.
For example, studies have found that hospitals and medical centers that perform a lot of hip and knee replacements tend to have lower complication rates than those performing fewer operations. As a result, there is a trend for people needing these surgeries to have them performed at high-volume centers. Similarly, surgeons who frequently perform hip or knee replacement surgery tend to have better results than ...
Source: Harvard Health Blog - January 22, 2021 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Surgery Source Type: blogs
ST Depression Maximal in V1-V4 and Angio shows 3 Vessel Disease. Is it posterior? Which is the culprit?
A 70-something woman had acute chest pain.The ECG was texted to me with the words: " Acute chest pain. Could this be posterior MI? What do you make of the ST depression in V4-V6? "What do you think?My response: " The ST depression is maximal in V1-V4. This is most consistent with a posterior MI. If it sounds clinically like acute MI then this is good for activating the cath lab. "Her response: " Yeah, I did activate. But the cardiology fellow told me he was sure it would not be a posterior MI because of diffuse ST depression. He suggested that we should have consulted cardiology rather than activati...
Source: Dr. Smith's ECG Blog - December 23, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
LA myxoma surgery : Preventing recurrence should be an important goal.
Cardiac myxoma is the most common primary tumor of the heart that presents as mitral inflow obstruction/ regurgitation often with a systemic presentation. It can be either familial, syndromic, or sporadic. Excellent imaging is possible and diagnosis has become straightforward. Surgery is the specific treatment,
What information do the Surgeons need?Â
Size, attachment to surrounding structures is the key. The myxoma origins most often in IAS and defining its attachment is crucial. Mitral leaflet distortion, Injury ( and even attachment) is possible. It is helpful for the surgeons if we let them know the mechanism of mit...
Source: Dr.S.Venkatesan MD - December 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiac myxoma IAS patch closure for myxoma LA myxoma surgery mesenchymal cell tumor myxoma myxoma benign or malignant Source Type: blogs
Will PCI reverse LV dysfunction in Ischemic cardiomyopathy ?
PCI is effective in relieving angina, what does it do to LV dysfunction?
This is a fundamental query in the principles of revascularisation of CAD . The term LV dysfunction can convey a bizarre meaning.It can constitute any of the combinations of the following.Cell death, necrosis, scarring, fully dead, partially dead, partially viable, apoptotic cells that are clustered across various myocardial segments. These cells are interwoven with fibrotic interstitium. Microvascular integrity is also altered.
Cells stretch, slip and slide with one another. Contractile architecture is lost. This is referred to as remodeling.In the...
Source: Dr.S.Venkatesan MD - December 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: CABG for Ischemic DCM Dilated cardiomyopathy Uncategorized How effective is pci in reversing lv dysfunction ? REHEAT STICH CABG PCI MEDICAL THERAPY revascularisation in ischemic dcm Source Type: blogs
New Technologies Drive Cost Growth Over Time
By KEN TERRY
(This is the eighth and final installment in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Medical technologies include drugs, devices, tests, and procedures. Considered as a whole, these technologies are the key driver of growth in health costs, according to Georgetown University professor Gregg Bloche and his associates.
Bloche, et al., view insurance coverage as the chief enabler of these technological innovations. In a 2017 Health Affairs Blog post, they said, â...
Source: The Health Care Blog - October 5, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Ken Terry Source Type: blogs
