Does non -IRA lesion status confuse you : Try a blind primary PCI !
Primary PCI of IRA is a legally, & globally validated (of course with lots of ifs & buts) coronary reperfusion strategy.
What to do, if we happen to detect, a significant or borderline lesion in non- IRA territory ?
There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is practiced by s...
Source: Dr.S.Venkatesan MD - April 13, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Does the “ Non -IRA ” lesion status confuse you often ?..Try a blind primary PCI !
Primary PCI of IRA , continues to be a clinically & statisticaly validated (Inspite of some ifs & buts) coronary reperfusion strategy.
What to do, if we happen to detect, a significant or borderline lesion in non- IRA territory ?
There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is prac...
Source: Dr.S.Venkatesan MD - April 13, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Intravascular Ultrasound (IVUS) for Coronary Intervention
Coronary Intravascular Ultrasound (IVUS) equipment consists of an IVUS catheter, pullback device and the imaging console. If lesion lengths have to be assessed, motorized pullback is required. For assessing lesion morphology a manual pullback can also be done. While manual pullback allows concentration on specific lesions, it may miss some lesions in between if the pullback is not steady. Catheter has to be disengaged while evaluating coronary ostial lesions.
Heparin and intracoronary nitroglycerine are given before the guide wire is inserted after the coronary cannulation with a guide catheter. The IVUS catheter is then i...
Source: Cardiophile MD - April 11, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Ballooning an obstructed prosthetic Aortic valve : Can be a real tense procedure!
A 76-year-old woman with a history of double valve replacement (Aortic and mitral valves) for rheumatic heart disease, presented with acute dyspnea after a switch from Warfarin to LMWH before a planned bone marrow biopsy.
The investigations revealed a stuck aortic prosthetic valve ,that showed a prohibitive gradient of more than 50 mmhg. Since, she refused further surgery, a rare and risky effort was made to balloon dilate the prosthetic valve leaflet, though it is not a standard approved modality. It was decided to dilate the supero-lateral orifice and the central orifices by simultaneous kissing balloon. The results w...
Source: Dr.S.Venkatesan MD - April 10, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Mitral prosthetic valve-Surgical tips and techniques prosthetic valve dysfunction prosthetic valves prosthetic valves -Technical issues Uncategorized balloon dilatation of prosthetic valve best review article on prosthetic valve obstruction Source Type: blogs
A 50-something with chest pain. Is there OMI? And what is the rhythm?
Written by Willy FrickA man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown:What do you think?The history thus far is highly suggestive of OMI, so we must study the ECG very closely to see if we can confirm this. Looking at the rhythm strip, we see there is more going on than simple sinus rhythm, and in fact there are two different morphologies of QRS complexes. Take a closer look at the rhythm by itself and see if you can figure out what ' s going on before scrolling further....
Source: Dr. Smith's ECG Blog - March 22, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
TIMI Thrombus Grade
Transcript of the video: TIMI Thrombus Grade is useful for quantification of thrombus which is detected angiographically, mainly for study purposes, but also for day to day use. There are six grades, starting from grade 0 to grade 5. Grade 0 is no thrombus, while grade 5 is total occlusion of the vessel due to thrombus formation.
These are the grade, TIMI grades, named after the landmark Thrombolysis In Myocardial Infarction trial. Grade 0, no angiographic evidence of thrombus. Grade 1, possible thrombus present, grade 2, small thrombus, grade 3, moderate thrombus, grade 4, large sized thrombus and grade 5, total occlusion...
Source: Cardiophile MD - March 21, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Excimer Laser Coronary Angioplasty
Transcript of the video: Conventional balloon angioplasty enlarges the vessel a bit as well as plasters the plaque on to the vessel wall, while laser angioplasty is a new technique, also known as laser atherectomy, in which excimer laser, which is a monochromatic source of light, is used to vaporize the plaque or thrombus by producing heat and shock waves. The most important advantage of laser angioplasty or excimer laser angioplasty, is that you need only a standard guidwire, 0.014 inch standard guide wire, unlike the other atherectomy devices which require a bulkier guidewire.
Diagrammatic representation of laser angiopl...
Source: Cardiophile MD - March 21, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Evaluation of JVP
Transcript of the video: Now we will discuss the basic principles of evaluation of jugular venous pressure and jugular venous pulse. These are assessed in the internal jugular vein and not in the external jugular vein. To revise the anatomy lessons, this is the external jugular vein and this is the internal jugular vein. Now, why we should not be looking at external jugual vein, though it is much easier to find out is that, in lower portion, it may be kinked so that it may not reflect the true right atrial pressure. The whole purpose of assessing the jugular venous pressure and pulse is that it reflects the right atrial pr...
Source: Cardiophile MD - March 21, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
When the conventional algorithm diagnoses the ECG as COMPLETELY NORMAL, but there is in fact OMI, what does the Queen of Hearts PM Cardio AI app say? (with 10 case examples)
Conclusions Need Scrutiny.Proximal LAD Occlusion with STE in I and aVL, and hyperacute T-waves in V2-V6.Algorithm: Marquette 12 SL (GE)The Queen gets it rightCase 9 (prehospital and ED ECGs). Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. The ECG told the story. 30 yo woman with trapezius pain. HEART Pathway = 0. Computer " Normal " ECG. Reality: ECG is Diagnostic of LAD Occlusion.Prehospital ECG:There are hyperacute T-waves in V3-V5.The Queen gets it rightFirst ED ECG:Hyperacute T-waves persist. Called normal again! Algorithm: Veritas (on Mortara...
Source: Dr. Smith's ECG Blog - March 4, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why Flight Emergency Medical Kits Need A Digital Health Upgrade
A few weeks ago a doctor used an Apple Watch to aid an elderly woman who suffered a medical emergency on a flight. NHS doctor Rashid Riaz, from Hereford, borrowed the device from a flight attendant to check the patient’s oxygen levels.
“The Apple Watch helped me find out the patient had low oxygen saturation,” the medic explained. Later, he also called on all airlines to consider having emergency physician kits as standard, which would ideally include tools to take basic measurements, diabetic and blood pressure meters, and an oxygen saturation monitor.
We all know that aircraft have some medical su...
Source: The Medical Futurist - February 27, 2024 Category: Information Technology Authors: berci.mesko Tags: Future of Medicine Health Sensors & Trackers portable diagnostics emergency medicine Healthcare technology flight medicine wearables Source Type: blogs
Chest pain, ST Elevation, well-formed Q-waves, and infarction with peak hs troponin I over 1000 ng/L. Is it OMI?
A 60-something male presented stating that he had had chest pain that morning which awoke him from sleep but then resolved after several minutes. He has had similar pain in the past which he attributed to acid reflux. He has a history of untreated hypertension.He is pain free now.His systolic BP was 200.The patient is pain free at the time of this ECG:What do you think?The conventional algorithm said:SINUS RHYTHMANTERIOR MYOCARDIAL INFARCTION , PROBABLY RECENT [40+ ms Q WAVE AND/OR ST/T ABNORMALITY IN V3/V4]***ACUTE MI*** There are well-formed Q-waves in precordial leads. The T-waves are inverted.&nb...
Source: Dr. Smith's ECG Blog - January 31, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.
This article,published this month (!), tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal:Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage PatientsI reviewed this article for a different journal and recommended rejection and it was rejected. There were zero patients in this study with a " normal " ECG who had any kind of ACS! This defies all previous data on acute MI which would show that even undetectable troponins do not have a 100% negative predictive value.&nb...
Source: Dr. Smith's ECG Blog - January 27, 2024 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Noisy, low amplitude ECG in a patient with chest pain
Written by Colin Jenkins. Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. Edits by Willy Frick.A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They denied fever, cough, dyspnea, and sick contacts. They described the chest pain as severe, crushing, and non-radiating. It was not wo...
Source: Dr. Smith's ECG Blog - January 15, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
An unusual query in Wellen ’ s syndrome ?
What will happen if you happen to thrombolyse Wellen syndrome?
Will evolve into STEMI by prothrombotic trigger of lytic agent
ECG will get normalised with clinical stability in some
Nothing happens. ECG will remain same.
Worsen the situation in majority
Will be severely reprimanded by your consultant and peers.
Answer:
4 will be answer for most of us , while 2 and 3 is a lesser, but distinct possibility. I have never seen 1 happen .Whatever is the correct answer , response 5 will always be correct.
What is the criteria to diagnose Wellen syndrome ?
The criteria used to diagnose Wellen...
Source: Dr.S.Venkatesan MD - January 14, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
An unusual query in Wellen ’ s syndrome
What will happen if you happen to thrombolyse Wellen syndrome?
Will evolve into STEMI by prothrombotic trigger of lytic agent
ECG will get normalised with clinical stability in some
Nothing happens. ECG will remain same.
Worsen the situation in majority
Will be severely reprimanded by your consultant and peers.
Answer:
4 will be answer for most of us , while 2 and 3 is a lesser, but distinct possibility. I have never seen 1 happen .Whatever is the correct answer , response 5 will always be correct.
What is the criteria to diagnose Wellen syndrome ?
The criteria used to diagnose Wellen...
Source: Dr.S.Venkatesan MD - January 14, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
