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
LVH with expected repolarization abnormalities, or acute OMI?
A patient with DM presented with acute chest pain.Here was his ED ECG:There isLVH in limb leads, with a 17 mm R-wave in aVL, and deep S-wave in inferior leads.With this much voltage, one expects some repolarization abnormalities.Indeed, there is a bit of ST depression in aVL (discordant to the tall R-wave) that does not appear to be out of proportion.There is inferior ST Elevation, but the S-waves are also of high voltage.Is this an inferior STEMI? Or is the LVH with expected repolarization abnormalities? There is also some ST depression in V2. Possible posterior involvement?CommentTo me, the inferior ST E...
Source: Dr. Smith's ECG Blog - May 18, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Do you want to be interrupted to view what the computer calls normal or nonspecific ECGs? 2 cases at once!
Two CasesMale PatientI was handed this ECG of a 40-something male patient. It was recorded at triage. The chief complaint was " chest pain. "The computer interpretation was " Nonspecific "What do you think?Female PatientAt the exact same time, I was viewing the computer queue of unconfirmed ECGs (read by computer but not yet overread by physician) and saw this one from a 40-something woman, about whom I knew nothing:The computer interpretation was: " Normal ECG "What do you think?Male Patient:When I saw the first one, on a 40-something male, I knew it was anewinferior MI (minimal STE in III with reciprocal STD ...
Source: Dr. Smith's ECG Blog - March 27, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ Test 2
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Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 1
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Source: Cardiophile MD - June 28, 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
DM / DNB Cardiology Entrance Mock Test 25
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Source: Cardiophile MD - April 4, 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
DM / DNB Cardiology Entrance Mock Test 14
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Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 14.
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Source: Cardiophile MD - February 7, 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
STE in aVR and diffuse ST depression: It can be ACS or demand ischemia. If ACS, either posterior STEMI or subendocardial ischemia!
A middle-aged male with a history of 2-vessel coronary bypass called 911 because of the relatively sudden onset of severe SOB. He had had more mild SOB for the past 2 days. The medics found him in respiratory distress with coarse breath sounds, a BP of 196/132, oxygen saturations of 90%, and a pulse of 130. They put him on CPAP for respiratory support. He denied chest pain.Here is his prehospital ECG:There is diffuse ST depression, with ST elevation in lead aVRThe patient arrived in the ED and was put on Noninvasive ventilation (BiPAP). Blood Pressure was 200/110. A nitroglycerin drip wa...
Source: Dr. Smith's ECG Blog - November 16, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Glycoprotein IIb/IIIa receptor antagonist – Cardiology MCQ
Which of the following is not a glycoprotein IIb/IIIa receptor antagonist?
a) Eptifibatide
b) Tirofiban
c) Abciximab
d) Apixaban
Correct answer: d) Apixaban
Apixaban is an oral is a direct factor Xa inhibitor, while all the others are glycoprotein IIb/IIIa receptor antagonists, which are given parenterally. Apixaban is used for prophylaxis against deep vein thrombosis after orthopedic surgery and for other antithrombotic applications. Glycoprotein IIb/IIIa receptor antagonists are mostly used in the setting of percutaneous coronary interventions. Glycoprotein IIb/IIIa receptor is the final common pathway in platelet activ...
Source: Cardiophile MD - May 28, 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
ABA Health Law Webinars and Events: Off-Label Marketing and Free Speech; FDA Medical Device Law Fundamentals
Wednesday, 11/12/14: Off-label Marketing and Free Speech: Caronia and the Future of Speech in Therapeutic Product Promotion
Information:
The landmark decision in U.S. v. Caronia has emboldened drugs and biologics makers to contest charges of off-label marketing, including the currently pending California False Claims Act case regarding unapproved uses of Integrilin. This webinar will focus on Caronia and other First Amendment cases, including IMS Health Inc. v. Sorrell, evaluating the prosecution of off-label promotion against the therapeutic products industries.
The webinar will:
Provide participants ...
Source: Policy and Medicine - November 5, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
PhRMA and DOJ Go Back and Forth Over Off-Label Speech and the First Amendment
A whistleblower’s False Claims Act (FCA) suit in the Eastern District of California has caught the attention of the Pharmaceutical Research and Manufacturers of America (PhRMA) and subsequently the Department of Justice, both of whom have filed amicus curiae briefs in the federal court. PhRMA re-responded to DOJ just last week, underscoring the case's importance. See that response here: PhRMA-Brief-Solis-v-Millennium.
Whistleblower Complaint
Frank Solis, a former sales rep at Schering-Plough (now part of Merck) and Millennium Pharmaceuticals, alleged that the two manufacturers illegally marketed ...
Source: Policy and Medicine - September 17, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG
This study demonstrates the importance of frequent static ECG’s and the insensitivity of using only 2 static ECG’s to detect reperfusion. In 58% of patients, ST segments were unstable, rising and falling, before final resolution.Infrequent static ECG’sCaliff RM et al., Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis, 1988. Methods: Califf et al. (339) performed angiography on 386 TAMI patients at 60 and 90 minutes post-administration of tissue plasminogen activator (tPA). They recorded a baseline ECG and another at 90 minutes post-tPA, before ...
Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Wellens' waves appear and disappear again and again, all troponins negative: Unstable Angina
This middle-aged woman presented with increasing intermittent substernal chest discomfort similar to her GERD, but not relieved by the usual therapies. She was given an aspirin. She had the following ECG recorded in the ED:A very astute physician read this as "biphasic T-waves in V3 and V4." There is also T-wave inversion in aVL. This is very suggestive of Wellens' syndrome with a proximal LAD lesion.A subsequent ECG was recorded:Not much changedThe patient was admitted to observation. Her troponins [Ortho Clinical Diagnostics, Limit of detection is 0.012 mcg/L, 99% reference value ("positive"...
Source: Dr. Smith's ECG Blog - June 17, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Non STEMI that needs the cath lab now.
A male in his 60's called 911 for chest pain. He had some cardiac risk factors including hypertension, on meds, but no previous coronary disease. His pain was intermittent and he was vague about when it was present and when it was resolved. Here is his prehospital ECG:Diagnosis? He had an immediate ED ECG:There is artifact, but the findings appear to be largely gone nowThe diagnosis is acute MI, but not STEMI. There is slight ST elevation in lead III with reciprocal ST depression in aVL. The T-wave is inverted in III, indicating reperfusion (what I like to call "inferior Wellens' s...
Source: Dr. Smith's ECG Blog - April 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Microfluidic Device Mimics Coronary Arteries for Personalized Testing of Anti-Coagulants
Aspirin and other blood thinners are often prescribed to help prevent formation of thrombi that can lead to strokes and heart attacks. While these can be very effective, their benefit seems to vary greatly patient to patient. The reasons are still not well understood, but having a handy tool to evaluate how a drug affects the coagulation of the patient’s own blood before making a prescription would significantly improve antiplatelet therapy.
Researchers at Georgia Tech have developed and tested a new device that puts blood through mechanical stresses, such as found within narrow dynamic vasculature, while seeing how...
Source: Medgadget - March 24, 2014 Category: Technology Consultants Authors: Editors Tags: in the news... Source Type: blogs
