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Percutaneous left ventricular assist devices
This study also documented significantly greater increases in cardiac index and mean arterial blood pressure as well as significantly greater decreases in pulmonary capillary wedge pressure with TandemHeart. Severe adverse events and overall mortality were not significantly different between the two groups. So we need more large scale studies on both types of percutaneous left ventricular assist devices and possibly improvements in their technical aspects to have a greater impact on survival in cardiogenic shock. Ongoing DanShock trial is one such study to look forward to. References Ergle K, Parto P, Krim SR. Percutaneou...
Source: Cardiophile MD - June 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

HOST-EXAM trial
This study is definitely hypothesis generating and calls for a multi national, double blind comparison on a larger scale to get a better conclusion on long term antiplatelet monotherapy after PCI with DES. AUGUSTUS trial A somewhat similar disadvantage for aspirin was suggested in the AUGUSTUS trial among patients with atrial fibrillation and recent ACS or PCI [2]. Adding apixaban to P2Y12 inhibitor resulted in lower bleeding compared with vitamin K antagonist and a lower rate of death or rehospitalization. Addition of aspirin resulted in greater bleeding without any difference in efficacy. 92.6% of the patients...
Source: Cardiophile MD - June 15, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

This patient with " NSTEMI " was not allowed to go to the cath lab. Then the ED provider obtained an emergent coronary CT angio. What do you think it showed?
Submitted by Shakita Crichlow MD, edits by MeyersA female in her 60s presented with chest pain off and on starting the day before presentation. The chest pain was left sided, pressure-like, intermittent, without aggravating or alleviating factors, and associated with mild shortness of breath. She become worried when she took her blood pressure at home and found it to be 200 systolic, so she decided to come to the ED at that point. Here is her initial ECG:What do you think?Raw findings: - Sinus rhythm - STE in leads II, III, and aVF, reaching at least 1.0 mm in III and aVF - Large Q wave in lead II...
Source: Dr. Smith's ECG Blog - April 30, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

Basic principles of rotablation
Rotablation or rotational atherectomy uses a diamond coated burr to debulk complex atherosclerotic plaques which are difficult to treat with conventional balloon angioplasty. The physical principle of rotablation is differential cutting. The advancing rotablator burr selectively cuts inelastic material while elastic tissue deflects away from the burr. As 95% of the particles generated by rotablation are less than 5 microns in diameter, they are removed from the body by the reticuloendothelial system [1]. Thus the basic principle of rotablation is quite different from balloon dilatation in which there is displacement of a...
Source: Cardiophile MD - April 28, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs

Neoatherosclerosis
Neointimal proliferation can occur within a coronary stent. Chronic inflammation within the neointima with infiltration of macrophages leads to neoatherosclerosis and result in in-stent restenosis. Disruption of neoatheroma can cause acute thrombotic occlusion [1]. Hence neoatherosclerosis is a complication of percutaneous coronary intervention and can present with recurrence of angina or acute coronary syndrome. Occurrence of neoatherosclerosis is earlier in drug eluting stents than in bare metal stents and has a greater prevalence. Late stent thrombosis due to rupture of the plaques with thin fibrous cap is associated ...
Source: Cardiophile MD - April 26, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

TASTE Trial – Review
TASTE Trial – Review TASTE trial (Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction) was a multicenter, prospective, randomized open label study which enrolled 7244 patients from the Swedish Coronary Angiography and Angioplasty Registry [1]. The patients with ST elevation myocardial infarction were assigned to either percutaneous coronary intervention (PCI) with manual thrombus aspiration or PCI alone. Primary endpoint of the study was 30 day all-cause mortality. Mortality was 2.8% in the thrombus aspiration group and 3.0% in the PCI only group, which was not a statistically significant differenc...
Source: Cardiophile MD - April 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions 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

ISAR-REACT 5 Trial – Review
ISAR-REACT 5 Trial – Review ISAR-REACT 5 Trial [1] was a multicenter study with randomized patients who presented which acute coronary syndrome for whom an invasive strategy was planned, to either ticagrelor or prasugrel. It was an open label trial. Primary end point was a composite of death, myocardial infarction or stroke at one year. A major secondary safety endpoint was bleeding. This was an investigator-initiated trial funded by German Center for Cardiovascular Research and Deutsches Herzzentrum München (German Heart Center Munich). 4,018 patients were randomized in the study. Primary composite endpoint occurr...
Source: Cardiophile MD - April 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology 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

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

Antegrade dissection and re-entry for chronic total occlusions
Antegrade dissection and re-entry for chronic total occlusions: Opening up of chronic total occlusions (generally more than 3 months old) is always challenging. While attempting to wire a chronic total occlusion (CTO), the wire can go subintimally and then renter the true lumen distally. Unless there is guidance with intravascular ultrasound (IVUS) or optical coherence tomography (OCT), it is almost a blind try. In the technique known as sub-intimal tracking and re-entry (STAR) technique, a knuckled wire was passed [1]. But this produced an uncontrolled re-entry, sometimes very distally near a bifurcation. Stenting then w...
Source: Cardiophile MD - June 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs

Supersaturated Oxygen Therapy Cleared in EU to Treat Widowmaker Heart Attacks
ZOLL Medical, a part of the Asahi Kasei Group, won EU clearance for its SuperSaturated Oxygen (SSO2) Therapy System to be used to minimize the damage that heart attacks cause within heart muscle. Approved about a year ago in the United States, SSO2 is the only option beyond percutaneous coronary intervention (stenting) that can help stricken patients recover with improved outcomes. These days, heart attacks are usually treated by placing stents at the sites of narrowing coronary arteries. This has become a standard of care and interventional cardiologists can accurately place stents within minutes. Although blood f...
Source: Medgadget - May 6, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Source Type: blogs

Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?
This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates. A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms ...
Source: Harvard Health Blog - April 27, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Surgery Source Type: blogs

Stress echocardiography – MCQ – Answer
Stress echocardiography – MCQ – Answer Stress echocardiography is useful when – Correct answer: d) All of the above Hibernating myocardium is viable myocardium Low dose dobutamine infusion improves the contraction of hibernating myocardial segments which are chronically ischemic. Such patients may benefit from revascularization procedures like coronary artery bypass grafting or percutaneous coronary intervention. Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs

Confabulation of a cardiologist – post ISCHEMIA trial !
I have never found it difficult to retrogradely cross a dangerous epicardial collateral in complex CTO. Delivering a twin stent in a partial culotte strategy for a bifurc lesion has never tested my talents. Stenting a left main across the LAD, jailing the LCX with OCT support is my favorite time pass. Crushing a calcium infested diffuse long lesion with diamond-tipped ablator appear as breezy as shopping in a mall. But this one is really challenging What is that? Understanding these four studies (Ref 1-4 ). They dogmatically say medical management confers definitive protection in chronic coronary syndromes. It stretches...
Source: Dr.S.Venkatesan MD - November 17, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome acc esc guidelines scai pci ptca stable chd courage bari 2d orbita ischemia trials tips and tricks in ptca Source Type: blogs