The Use of Thrombolysis as a Treatment for Acute Stroke
Conclusion
Left deliberately blank.
..it is now up to you – the medical and the non-medical public to make up your mind…
The References
Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurology 2009 Feb.;8(2):141–150. PMCID 2730486
Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurology 2008 Apr.;7(4):299–309.PMID 18296121
Random...
Source: Life in the Fast Lane - October 7, 2013 Category: Emergency Medicine Doctors Authors: Michelle Johnston Tags: Education eLearning Emergency Medicine Featured IST-3 lysis Prof Daniel Fatovich Prof Simon Brown stroke Source Type: blogs
Thrombolytic therapy for patients with submassive PE: the controversy continues
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - September 30, 2013 Category: Internists and Doctors of Medicine Tags: cardiovascular pulmonary Source Type: blogs
Indication for thrombolysis
In a patient with chest pain and elevated cardiac troponin, which of the following is an indication for thrombolysis?
a) New onset left bundle branch block
b) New onset right bundle branch block
c) New onset complete heart block
d) New onset second degree AV block
Correct answer: a) New onset left bundle branch block
Thrombolytic therapy is indicated in ST elevation myocardial infarction and new onset left bundle branch block with features of myocardial infarction. In other situations described above, if ST elevation myocardial infarction is present, thrombolysis is indicated. All the other listed conditions will not mask...
Source: Cardiophile MD - September 18, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Top stories in health and medicine, August 26, 2013
From MedPage Today:
Depression: Can a Coach Help? Adding old-fashioned technology — the telephone — to a Web-based intervention for depression improved adherence to the intervention, but there was no symptom benefit.
Affording Care: A Medical Student’s Story. The Affordable Care Act as approved by Congress required all insurance plans to to limit personal out-of-pocket expenses to $6,350 for individual plans and $12,700 for family plans.
Outcomes Mixed for Brain Surgery in Epilepsy. Long-term follow-up in children undergoing hemispherectomy for refractory epilepsy showed that most were seizure-free and ...
Source: Kevin, M.D. - Medical Weblog - August 26, 2013 Category: Family Physicians Tags: News Medications Neurology Psychiatry Source Type: blogs
Low dose t-PA for prosthetic valve thrombosis in pregnancy
Low dose slow infusion of tissue plasminogen activator (t-PA) has been found to be useful in prosthetic valve thrombosis in pregnancy [Özkan M et al. Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator. Circulation. 2013;128:532-540]. Prosthetic valve thrombosis is a life threatening condition, more so in pregnancy with high maternal and fetal risk. Cardiac surgery in this setting carries high risk of maternal and fetal mortality. Efficacy of low dose t-PA (25 mg) given as a slow infusion given over 6 hours has been eval...
Source: Cardiophile MD - July 31, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Source Type: blogs
Cardiology MCQ Test 5
Cardiology MCQ Online 5
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You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. W...
Source: Cardiophile MD - July 15, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ Online 5
Time limit: 0
Quiz-summary
0 of 25 questions completed
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You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. We strongly advise you t...
Source: Cardiophile MD - July 15, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Large Transmural STEMI with Myocardial "Rupture" of Ventricular Septum
A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. There was some SOB. He had walked into the ED (did not use EMS). Here is his ECG:There is atrial fibrillation at a rate of 95. There is Right Bundle Branch Block with a QR particularly noted in V1-V3 (no rSR', as there is an initial Q-wave diagnostic of infarction in the anterior wall and septum). The Q-waves extend to V5 and are very wide (80 ms in V2). There are also inferior Q-waves which can mimic a left anterior fas...
Source: Dr. Smith's ECG Blog - July 7, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
PE thrombolysis in the elderly and those with comorbidities
A large observational study has shown a remarkable 50% reduction in the mortality rate of hemodynamically unstable patients with PE--who do not have absolute contraindications--when they are treated with thrombolytic therapy. (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - May 3, 2013 Category: Cardiology Authors: theheart.org Tags: Clotblog with Dr Samuel Goldhaber Source Type: blogs
Thrombolysis in PE: Results from PEITHO with Dr Stavros Konstantinides
It’s been 10 years in the making, but the eagerly awaited results of the PEITHO study point to the benefits of thrombolytic therapy--compared with anticoagulation alone--in patients with submassive PE. (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - March 12, 2013 Category: Cardiology Authors: theheart.org Tags: Clotblog with Dr Samuel Goldhaber Source Type: blogs
Thrombolysis in PE: Results from PEITHO with Stavros Konstantinides
It’s been 10 years in the making, but the eagerly awaited results of the PEITHO study point to the benefits of thrombolytic therapy--compared with anticoagulation alone--in patients with submassive PE. (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - March 12, 2013 Category: Cardiology Authors: theheart.org Tags: Clotblog with Dr Samuel Goldhaber Source Type: blogs
First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?
This male in his 40's had been having intermittent chest pain for one week. He awoke from sleep with crushing central chest pain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. He arrived in the ED and had this ECG recorded: There are Wellens' waves, type A (upsloping ST segment then inversion of the terminal part of the T-wave - terminal T-wave inversion, or biphasic T-waves) in V2-V4, and aVL. Type B waves are deeper and symmetric.When the patient had chest pain, prior to nitroglycerine, what do you ...
Source: Dr. Smith's ECG Blog - March 9, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Precordial ST depression. What is the diagnosis?
A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG:Here is the patient's previous ECG:NormalHere is the patient's presenting ED ECG:What do you think?There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation. Precordial ST depression may be subendocardial ischemia or posterior STEMI. How can we tell the difference? See the list below.If you thought it might be a posterior STEMI, then you might have ordered a posterior ECG [change leads V4...
Source: Dr. Smith's ECG Blog - January 1, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
