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Coronary perforation – Cardiology MCQ
Pericardial or myocardial blushing is Grade — in Ellis classification of coronary perforation during percutaneous coronary intervention (PCI): Grade I Grade II Grade III Grade IV Correct Answer: 2. Grade II Ellis classification is based on angiographic appearance of the perforation.1 Grade I: Extraluminal crater without extravasation Grade II: Pericardial or myocardial blushing Grade III: Perforations of one or more millimeter diameter with contrast streaming or spilling References Ellis SG et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation...
Source: Cardiophile MD - October 24, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology 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

Fentanyl reduces effectiveness of ticagrelor for PCI – PACIFY RCT
Fentanyl is an opioid which is routinely used for periprocedural relief of during percutaneous coronary intervention (PCI). Intravenous morphine has been shown to reduce the absorption of P2Y12 inhibitors, presumably by delaying gastric emptying [1]. Platelet Aggregation with tiCagrelor Inhibition and FentanYl (PACIFY) trial [2] evaluated the effect of intravenous fentanyl on the efficacy of ticagrelor. Ticagrelor plasma levels, platelet function and troponin levels were compared in a randomized trial with and without the use of fentanyl. There were 70 patients in this study who required PCI. Fentanyl arm had lower ticagr...
Source: Cardiophile MD - October 20, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Pharmaco-invasive strategy not a bad option – EARLY-MYO trial
(Representative image) Pharmaco-invasive strategy means early thrombolysis for followed by early percutaneous coronary intervention (PCI). In case where the delay in getting PCI is likely to be longer than what is recommended, there is a role for pharmaco-invasive strategy. EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment–Elevation Myocardial Infarction) [1] randomized patients with ST Elevation Myocardial Infarction (STEMI) presenting within 6 hours, but with expected delay in getting primary PCI (PPCI) into pharmaco-invasive strategy with initial half d...
Source: Cardiophile MD - October 18, 2017 Category: Cardiology Authors: Johnson Francis Tags: Coronary Interventions Source Type: blogs

Ignorance based Primary PCI : A landmark article that couldn ’ t correct our coronary Intellect !
How often you assess the success of Primary PCI with degree of ST segment regression or resolution ? I posed this query to a freshly hatched , Intelligent and energetic cardiologist in an upscale dedicated heart care center. He said, “No, we don’t .We always go with TIMI flow in IRA .TIMI 3 flow with less than 30% narrowing of IRA is success, that’s it ! He continued ,very often ,we don’t even Insist to take serial ECGs after the procedure . . . forget about analysing ST segment ! His body language seemed to suggest, he didn’t expect such a question (Silly !) from me , talking ...
Source: Dr.S.Venkatesan MD - September 29, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized pPCI primary pci stemi st segment regression more important than ira patency st segment regressionafter ppci timi blush score timi three flow Source Type: blogs

Out of hospital cardiac arrest
(OHCA) is a catastrophic event, which is equivalent to demise unless prompt cardiopulmonary resuscitation (CPR) and follow up care are available. Majority of the cardiac arrests occur at home (80%) and some of them at public places (20%). Only one fifth of them are in a shockable rhythm when the emergency medical services (EMS) arrive. There is a 10% decrease in survival on each passing minute after cardiac arrest. Bystander initiated CPR improves the chance of survival as it buys time till the arrival of EMS. The chance of receiving bystander CPR varies widely between countries and locations, with 43% in certain countrie...
Source: Cardiophile MD - May 9, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology AED automatic external defibrillator Bystander CPR bystander initiated CPR cardiopulmonary resuscitation Chain of Survival OCT OHCA Optical coherence tomography PCI Percutaneous coronary intervention public acces Source Type: blogs

MKSAP: 81-year-old man after a percutaneous coronary intervention
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history is significant for hypertension and type 2 diabetes mellitus. He has no risk factors for or history of significant bleeding. Medications are aspirin, clopidogrel, lisinopril, ...
Source: Kevin, M.D. - Medical Weblog - March 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs

Coronary artery disease: Primary care and prevention – 2
Previous Check for differential diagnosis Some of the important differential diagnosis in the case of acute coronary syndrome are acute pulmonary embolism, aortic dissection, pneumothorax, esophageal disease, perforated peptic ulcer, cholecystitis, gastritis and sometimes even Herpes Zoster of left thoracic region in pre-eruptive phase. A good history, physical findings and sometimes time are needed for an accurate differential diagnosis. Checking for asymmetry of peripheral pulses is often resorted to for excluding aortic dissection, though it may still miss an aortic dissection sparing the branches as in descending thora...
Source: Cardiophile MD - December 18, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs

Short Quiz on radio contrast (iodinated ‘ dye ’ )
Short quiz on contrast used for angiography. Quiz on radiocontrast Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Congratulations - you have completed Quiz on radiocontrast. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% Your answers are highlighted below. Question 1Iodixanol is a —- radiocontrast:AIso-osmolar...
Source: Cardiophile MD - December 9, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Bridging collaterals
are a feature of chronic total coronary occlusions (CTO). They bridge between the proximal and distal parts of a coronary artery which is chronically occluded in between. Presence of bridging collaterals, though physiologically useful for providing distal perfusion, could create problem during attempted percutaneous coronary intervention (PCI). A guidewire passed from the proximal segment, instead of passing into the occluded segment, is likely to take the easy way out into the bridging collaterals. The coronary angiogram shows bridging collaterals in a post coronary artery bypass right coronary CTO. Sternal wires indica...
Source: Cardiophile MD - November 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology Source Type: blogs

Inferolateral myocardial infarction P
ST segment elevation is seen in inferolateral leads (II, III, aVF, V5, V6) indicating inferolateral ST elevation myocardial infarction (STEMI). There is a discordance between the ST segment in aVL and V6 – there is ST segment depression in aVL while the ST segment is minimally elevated in V6. STEMI is an indication immediate angiography and percutaneous coronary intervention (PCI). If that is not feasible, either the patient can be transferred to a PCI capable center or thrombolytic therapy administered if there are no contraindications. Differential diagnosis of this pattern is of course an early repolarization (ERP...
Source: Cardiophile MD - November 5, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology ECG / Electrophysiology ECG Library Source Type: blogs

Predictors of contrast induced AKI – Cardiology MCQ
Predictors of contrast induced acute kidney injury: a) Estimated glomerular filtration rate (eGFR) b) ST elevation myocardial infarction (STEMI) c) Cardiogenic shock d) All of the above e) None of the above Correct answer: d) All of the above These are also the strongest predictors of AKI requiring dialysis. Roxana Mehran and associates developed a comprehensive risk prediction score which included age, hemoglobin level, pre-existing chronic kidney disease, volume of contrast administered during the percutaneous intervention, need for IABP (intra aortic balloon counterpulsation) and a few other variables. Presen...
Source: Cardiophile MD - October 31, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Kokeshi phenomenon: stuck rotablator burr
Kokeshi phenomenon is a stuck rotablator burr in a heavily calcified coronary artery during attempted rotablation. Though it is a rare complication, it is a potentially serious one as it can cause coronary occlusion and necessitate emergency surgery. Different methods have been described for retrieval of the stuck burr. Mechery A and associates noted that deep engagement of the guiding catheter and manual traction is a safe method for retrieval of the burr [1]. Tanaka Y et al used a modified STAR (subintimal tracking and re-entry) technique using a 3 g tapered tip hydrophilic wire to remove the burr [2]. Successful removal...
Source: Cardiophile MD - July 19, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology Coronary Interventions Source Type: blogs

Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better. Recommended by Anand Swaminathan The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ this! R&R Hot stuff! Everyone’s going to be talking about this R&R Landmark paper A paper that made a difference R&R Game Changer? Might change your clinical practice R&R Eureka! Revolut...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs

Don ’ t hunt for non-existing culprits in STEMI crime scene !
Scientific cardiology has forced us to believe ACS management must be catheter based and all others are inferior and those who pursue the later , carry a risk of being labelled as unethical in near future. However ,experienced cardiologists will know where the truth lies. Now,in the interventional cardiology board rooms there is a big debate going on regarding the value of early total revascualrisation in STEMI with multivessel CAD.Suddenly , every lesion looks suspect ( Ex,current or future culprit ! ) and all stentable lesion are stented either in an emergency or semi emergency fashion (The new age post PC...
Source: Dr.S.Venkatesan MD - June 22, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -unresolved questions Primary PCI diferred pci for non ira ira non ira culprit vessels multivessel pci in stemi Source Type: blogs