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
The 10 Trends Shaping the Future of Pharma
The drug sends a message to a caregiver after the patient swallowed it. The doctor prescribes virtual reality treatments for migraines. Do you think it is science fiction? You are mistaken.
The pharma industry has taken a big swung into digital transformation. All participants invest in digital health topics. But as with all trending issues, and there is a lot of fuss that is hard to see through. As the medical community increasingly acknowledges the importance of digital health, the cultural shift we so often talk about is still a way to go. To change that, the first step is always getting to know what’s coming.
...
Source: The Medical Futurist - August 26, 2021 Category: Information Technology Authors: berci.mesko Tags: Future of Medicine Future of Pharma 3d printing artificial intelligence augmented reality digital health Innovation nanotechnology Personalized medicine pharmacology virtual reality VR gc4 pharmacies pharmacogenetics Source Type: blogs
The 9 Trends Shaping the Future of Pharma
The drug sends a message to a caregiver after the patient swallowed it. The doctor prescribes virtual reality treatments for migraines. Do you think it is science fiction? You are mistaken. Just let me familiarize you with the top 10 trends shaping the future of pharma.
And if you want to have a more in-depth analysis of the topic, read our related ebook, Technologies Shaping the Future of Pharma!
Technologies Shaping the Future of Pharma
We designed this e-book to serve as a collection of relevant examples, best practic...
Source: The Medical Futurist - August 26, 2021 Category: Information Technology Authors: berci.mesko Tags: Future of Medicine Future of Pharma 3d printing artificial intelligence augmented reality digital health Innovation nanotechnology Personalized medicine pharmacology virtual reality VR gc4 pharmacies pharmacogenetics Source Type: blogs
Hypotension, altered mental status, and aVR sign - activate the cath lab?
ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - July 21, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !)
What is an intermediate coronary lesion? (ICL)
Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any revascularisation debate).
Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet named th...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs
Paroxysmal Atrial Fibrillation with RVR, hypotension, volume depletion, good EF, AND pulmonary edema. Strange. Why? What to do?
A 30-something woman presented with a few days of feeling ill. She had a history of paroxysmal atrial fibrillation, bio-prosthetic mitral valve, and tricuspid valvuloplasty, and was on Coumadin.Records showed she is usually in sinus rhythm and has normal LV function.She presented hypotensive (systolic pressure 80), with diffuse B lines, flat IVC, good LV function, and an irregular, fast heart beat.Here is here ECG:Atrial fib with RVR and some probable ischemic ST depression in V3-V6Here is her POCUS:What do you think? There is asmall LV with good function and alarge left atrium, andmoderately large RV.Ther...
Source: Dr. Smith's ECG Blog - April 4, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Heart disease in pregnancy: Overview & management
Some of the questions addressed in this presentation
1.What happens to fetal blood pressure during maternal hypotension how good is fetal autoregulation?
2.Why is LSCS increasingly preferred mode of delivery in heart disease complicating pregnancy challenging the traditional scientific concept?
3.What is likely hood of patients with moderate mitral stenosis developing pulmonary edema during prolonged 2nd stage of labor?
3.What is the missing link between PIH and PPCM? How prepartum cardiomyopathy differs from postpartum?
4.Is Eisenemneger really an absolute contraindication for pregnancy?
5. How can we continue VKAs wa...
Source: Dr.S.Venkatesan MD - April 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Pregnancy and heart pregnancy and heart disease cardiac disease in pregnancy esc aha pregnancy heart disease fetal aortic blood Source Type: blogs
Chest pain with ventricular paced rhythm - will you be able to rise above the STEMI paradigm and figure out what to do?
Submitted by Marie Wofford MD and Mark Kastner MD, edits by Smith and MeyersAn 86 year old with prior history of CAD and PCI, aortic stenosis, pacemaker, atrial fibrillation on warfarin, hypertension, etc., presents with sudden onset mid back pain radiating to the left shoulder and chest. His vital signs were within normal limits with the exception of tachypnea at 22/min. The EMS ECG is shown below:What do you think?The ECG shows ventricular paced rhythm (the pacer spikes are barely visible to me in lead V2), resulting in almost LBBB morphology (LBBB morphology would require upright usually monophasic R waves in I an...
Source: Dr. Smith's ECG Blog - March 1, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
“Never stop wondering” — Sharon Begley, science journalist, RIP
This article was adapted by arrangement with Hudson Street Press, a member of Penguin Group (USA) Inc., from The Emotional Life of Your Brain: How Its Unique Patterns Affect the Way You Think, Feel, and Live–and How You Can Change Them by Richard J. Davidson, Ph.D., and Sharon Begley. Copyright by Richard J. Davidson, Ph.D., and Sharon Begley.The post “Never stop wondering” — Sharon Begley, science journalist, RIP first appeared on SharpBrains. (Source: SharpBrains)
Source: SharpBrains - January 21, 2021 Category: Neuroscience Authors: Alvaro Fernandez Tags: Education & Lifelong Learning books on brain brain-functions Courtney Nobile emotional style Emotions neuroplasticity relationships Resiliency Richard-Davidson Sharon-Begley Source Type: blogs
CBD and other medications: Proceed with caution
Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
Doubling up on side effects
While generally considered safe...
Source: Harvard Health Blog - January 11, 2021 Category: Consumer Health News Authors: Katsiaryna Bykov, PharmD, ScD Tags: Drugs and Supplements Marijuana Medical Research Safety Source Type: blogs
Fight Aging! Newsletter, December 14th 2020
In conclusion, aging alters the cerebral vasculature to impair mitochondrial function and mitophagy and increase IL-6 levels. These alterations may impair BBB integrity and potentially reduce cerebrovascular health with aging.
Senescent Cells Fail to Maintain Proteostasis
https://www.fightaging.org/archives/2020/12/senescent-cells-fail-to-maintain-proteostasis/
Given the newfound consensus in the research community regarding the importance of senescent cells to degenerative aging, it isn't surprising to see a great deal more fundamental research into the biochemistry of cellular senescence now taking pl...
Source: Fight Aging! - December 13, 2020 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Relating Warfarin, Vitamin K, and Cellular Senescence in the Progression of Aortic Calcification
Calcification of blood vessel walls progresses with age, an issue that sees cells behave as through they are in bone tissue, a maladaptive reaction to the altered signaling environment and damage of aged tissue. The resulting deposition of calcium makes normally flexible cardiovascular tissue stiff and dysfunctional, ultimately contributing to disease and death. Evidence has accumulated in recent years for the accumulation of senescent cells to be an important contributing factor to calcification. Senescent cells grow in number with age and secrete the senescence-associated secretory phenotype (SASP), signals that rouse th...
Source: Fight Aging! - December 7, 2020 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Why AF is often well tolerated in Hypertrophic cardiomyopathy ?
Up to 25 % of LV filling is done by atrial contraction. Atrial booster function is important in LV outflow lesions. This can be critical in patients who have diastolic deformities of LV. ( an audible or even palpable S4 confirms the atrial kick in these situations ) This is how we were taught for decades right. Still, it may hold good in many left-sided condtions, but in HCM it definitely seems to be not true.
A succinct review of this topic makes a good read.
Incidence if AF in HCM is about 20% (Mostly paroxysmal 70 % , Persistent /Permanent 30 %)
Mechanism of AF IN HCM
Incre...
Source: Dr.S.Venkatesan MD - November 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation af in hocm affirm study atrial fibrillation in hypertrophic cardiomyopathy current guidelines in hcm hcm hocm mechansim of af in hcm pathophysiologyof hcm Source Type: blogs
DAPT blues in ACS : Does Prasugrel really bother to know about the coronary anatomy before it acts ?
It appears,antiplatelet agents are waging a turf war on the CAD battlefield. It is no secret either, the fight often goes beyond academic reasons. Though NSTEMI connotes a true cardiac emergency, it consists of a highly heterogeneous population. A patient with UA can be treated even at home (Low-grade angina with little ECG changes, when it’s due to Increase demand situation). While, in the other extreme of NSTEMI, a patient with a GRACE score >200, in Ischemic LVF, might need an emergency multivessel angioplasty along with Mitra clip ± ECMO support.
Antiplatelet agents along with heparin will re...
Source: Dr.S.Venkatesan MD - October 19, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome oral anticoagulants warfarin acitrom prasugrel 2b3a vs prasugrel coronary anatomy in nsteacs dapt mapt NSTEMI guidelines esc acc 2020 prasugrel vs aspirin vs ticagrelor reopro vs prasugrel themis twilight study Source Type: blogs
Prosthetic heart valves on CXR
Approximate positions of the valves as seen on the CXR are marked in the picture below. A line connecting the pulmonary bay to the right cardiophrenic angle is used to get the positions of aortic and mitral valves. Mitral valve is below this line while aortic valve is above it. Tricuspid valve is a midline structure. But the actual positions may vary from case to case, especially with differential enlargement of the cardiac chambers. Most commonly replaced valves are the mitral and aortic, tricuspid next and pulmonary the least. Annuloplasty rings used for valve repair may also be seen on CXR.
Approximate positions of car...
Source: Cardiophile MD - September 30, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Ball and cage prosthesis Bjork Shiley valve CarboMedics bileaflet valve Medtronic Hall valve On-X bileaflet heart valve On-X valve Prosthetic mitral valve Prosthetic TTK Chitra aortic valve Prosthetic TTK Chitra mitral valve St. Ju Source Type: blogs
