Cath lab tips : Post dilatation is an unique “ Art ” . . . can ’ t learn it from textbooks or workshops !
In the modern era of cardiology, PCI has become the single therapeutic modality that determines the survival of both cardiologists and possibly their patients! The procedure is all about launching a metal coil inside the coronary artery of a live beating heart.
Millions of diseased and (not much) diseased coronary arteries are serviced (either re/deconstructed ) world-wide on a day-to-day basis.The benefits of the modality is directly related to the wisdom of treating cardiologist and patient’s luck than the original severity of the disease. However, with greatly improved coronary metallurgy , well assist...
Source: Dr.S.Venkatesan MD - December 24, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized post dilatation pre vs postdilatation ptca post dilatation Source Type: blogs
A 50-something with h/o coronary bypass has chest pain and a ventricular paced rhythm
Conclusions: ACO in VPR is an uncommon condition. The MSC showed good Sens for diagnosis of ACO in the presence of VPR, especially among patients with high peak cTn, and Spec was excellent. These methods and results are consistent with studies that have used the MSC to diagnose ACO in LBBB. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 3, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
" Steve, what do you think of this ECG in this Cardiac Arrest Patient? "
I was shown this ECG. The resident asked: " Steve, what do you think of this ECG in this Cardiac Arrest Patient? "What do you think?Here is more history:An elderly woman with h/o CAD and CABG presented after out of hospital cardiac arrest with subsequent resuscitation and return of spontaneous circulation. It was an unwitnessed arrest and down time was unknown. The initial prehospital rhythm was asystole.Here is the initial ED ECG:Rhythm is regular, but no definite P-waves are visible.There is a Brugada-like morphology in V1.There is profound ST elevation in lead III and aVF, with ST depression in aVLTher...
Source: Dr. Smith's ECG Blog - November 30, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Balanced myocardial ischaemia
If all three major coronary branches have similar degree of stenosis, the radionuclide used for perfusion study will have equal uptake in all regions of the myocardium. Thus a balanced three vessel coronary artery disease can produce a false negative myocardial perfusion scan. This situation is called balanced myocardial ischemia. In most cases this is picked up by the treadmill ECG usually done along with stress myocardial perfusion imaging. Since the ECG findings of myocardial ischemia does not depend on the relative perfusion in the coronary tree, ischemic changes will be noted in treadmill ECG even when nuclear perf...
Source: Cardiophile MD - November 20, 2017 Category: Cardiology Authors: Johnson Francis Tags: Nuclear Cardiology Source Type: blogs
DAPT score – Dual Antiplatelet Therapy Score
DAPT score (Dual Antiplatelet Therapy Score) was developed to dichotomize patients after percutaneous coronary intervention [PCI] into those who will benefit from prolonged DAPT (score 2 or more) and those who are more likely to be harmed by DAPT (score less than 2). A recent study evaluated DAPT with aspirin and clopidogrel given for 2 years vs 6 months in 1970 patients undergoing PCI [1]. Primary efficacy outcomes were death, myocardial infarction or cerebrovascular accident. Primary safety outcome was significant bleeding. In this retrospective study they concluded that prolonged DAPT resulted in harm in patients with l...
Source: Cardiophile MD - November 14, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Do angioplasties and coronary stenting improve symptoms in patients with angina?
Last week, the results of ORBITA were published. This clinical trial tested coronary angioplasty and stenting versus optimal medical management in patients with single-vessel coronary artery disease. It was a resoundingly negative trial, meaning that adding stenting to drug management didn’t result in detectable clinical improvement. What was distinctive about this trial is that it used a sham procedure (i.e., placebo) control, which few trials testing surgery or a procedure use. The results of ORBITA emphasize how important sham procedure controls are, whenever they can be ethically used, and how resistant physicians ca...
Source: Respectful Insolence - November 13, 2017 Category: Surgery Authors: Orac Tags: Clinical trials Medicine angina angioplasty coronary artery bypass graft ORBITA percutaneous coronary intervention stent Source Type: blogs
NACCE – Net Adverse Clinical and Cerebral Events
NACCE – Net Adverse Clinical and Cerebral Events is a new metric being measured in all recent clinical trials in cardiovascular medicine. NACCE is a composite of a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding [1].
NACE was another similar acronym introduced in the in the HORIZONS Trial [2].
NACE = net adverse clinical event(s)
NACE = (MACE + major bleeding unrelated to coronary artery bypass grafting)
MACE = major adverse cardiovascular event(s)
Components of MACE are death, reinfarction, ischemia-driven target vessel revascularization, and stroke.
Reference
Feres F et al. T...
Source: Cardiophile MD - November 11, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Practicing Medicine While Black
By KIP SULLIVAN, JD
The managed care movement thrives on misleading words and phrases. Perhaps the worst example is the incessant use of the word “quality” to characterize a problem that has multiple causes, only one of which might be inferior physician or hospital quality. [1] To illustrate with a non-medical analogy, no one would blame auto repair mechanics if 50 percent of their customers failed to bring their cars in for regular oil changes. We would attribute the underuse of mechanics’ services to forces far beyond the mechanic’s control and would not, therefore, refer to the problem as a “quality” problem...
Source: The Health Care Blog - November 9, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
12 Cases of Use of 3- and 4-variable formulas to differentiate normal STE from subtle LAD occlusion
Here are 12 Cases using the 3- and 4-variable formulas, which help to distinguish normal ST elevation in leads V2-V4 from that of subtle LAD occlusion.Instructions for using free subtleSTEMI iPhone app for the 3-variable formula. 4-variable version still to come.Here is a video lecture of subtle LAD occlusion: One hour lecture on Subtle ECG Findings of Coronary OcclusionThe 3-variable formula comes from this paper:Smith SW et al. Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. Annals of Emergency Medicine 2012;60:45-56....
Source: Dr. Smith's ECG Blog - November 3, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ Test 6
Time limit: 0
Quiz-summary
0 of 20 questions completed
Questions:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
...
Source: Cardiophile MD - October 27, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Professionalism And Choosing Wisely
The US health care system is plagued by the use of services that provide little clinical benefit. Estimates of expenditures on overuse of medical services range from 10–30 percent of total health care spending. These estimates are typically based on analyses of the geographic variation in patterns of care. For example, researchers at the Dartmouth Institute focused on differences in care use between high-spending and low-spending regions with no corresponding reductions in quality or outcomes. An analysis by the Network for Excellence in Health Innovation (formerly known as the New England Healthcare Institute) ident...
Source: Health Affairs Blog - October 24, 2017 Category: Health Management Authors: Michael Chernew and Daniel Wolfson Tags: Costs and Spending Quality Choosing Wisely inefficiency overuse of medical services Source Type: blogs
Cardiology MCQ Test 5
Time limit: 0
Quiz-summary
0 of 20 questions completed
Questions:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
...
Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
30-something with chest pain, a fragmented QRS, and ST Elevation.
A young man presented with acute chest pain. He had no cardiac history. He had no medical history at all. His vital signs were normal.Here was his first ED ECG:What do you think?Here is an old one, from 2 months prior:What do you think?Here I will show them again, with comment:This is very abnormal.There are deep QS-waves in V1-V3. QR-waves in V4 and I, aVLThere is a fragmented QRS in V3, which is all but diagnostic of old infarctionThere is ST depression in II, III, aVF.This looks like a very large old MI, butit also looks acute, as the T-waves are tall, too tall to assume this is LV...
Source: Dr. Smith's ECG Blog - October 21, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Best treatment option?
What would be the best treatment option for this person?
Intravenous magnesium
Intravenous lignocaine
Primary angioplasty
Intravenous tenecteplase
Coronary artery bypass grafting
Post your answer as a comment below with reasons in favor of your choice and against other options. (Source: Cardiophile MD)
Source: Cardiophile MD - October 13, 2017 Category: Cardiology Authors: Johnson Francis Tags: Cardiology ECG / Electrophysiology Source Type: blogs
Multiple arterial grafts give better long term results – Canadian study
(Representative image of multiple arterial revascularization)
A Canadian study [1] published in JAMA Cardiology has shown lower long term mortality, repeat revascularization, myocardial infarction and heart failure in patients receiving multiple arterial grafts as compared to those single LIMA (left internal mammary artery) graft along with SVG (saphenous vein grafts). Of over twenty thousand patients with triple vessel or left main disease who underwent CABG (coronary artery bypass graft), about 5600 received multiple arterial grafts and around 14500 received LIMA graft along with SVG. Subgroup analyses showed that the ...
Source: Cardiophile MD - October 12, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology CABG coronary artery bypass graft Coronary artery bypass grafting left main disease LIMA LITA RIMA RITA triple vessel disease Source Type: blogs
