P2-CHA2DS2-VASc Score
P2-CHA2DS2-VASc score adds additional two points to the CHA2DS2-VASc score for an abnormal P wave axis to predict risk of stroke in atrial fibrillation (AF) [1]. The seminal study was an attempt to identify utility of P wave indices in sinus rhythm to predict the risk of stroke over and above the existing CHA2DS2-VASc score. P wave indices evaluated were prolonged P wave duration, abnormal P wave axis, advanced interatrial block and abnormal P wave terminal force in lead V1. They found that abnormal P wave axis which is an ECG correlate of left atrial abnormality improves the prediction of ischemic stroke. They concluded ...
Source: Cardiophile MD - July 21, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Cardiology Image watch : Its not a stent for sure … then what ?
A 75-year-old male post CABG with severe LV dysfunction and ICD and dual-chamber pacer in situ presented with NSTEMI.
An angiogram revealed something, and he got this form of treatment. ? What is it?
Image and case courtesy Patel R, Ghadiam H, Patel P, et al. (April 05, 2020) Angina Leading to Metal in the Heart: An Interesting Case of Saphenous Vein Graft Coiling. Cureus 12(4): e7546. doi:10.7759/cureus.7546
Features of SVG venous graft aneurysm
Graft aneurysm what are the risks?
Thrombosis
Recurrent ACS
Rupture
Management
Vascular plug
Multip...
Source: Dr.S.Venkatesan MD - July 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coil occlusion of coronary aneurysm post cabg coronary aneurysm SVG graft aneurysm Source Type: blogs
A 64 year old man with chest tightness
Submitted and written by Kaley El-Arab MDPeer reviewed by Pendell Meyers, Alex Bracey, Stephen Smith A 64-year-old male with past medical history of coronary artery disease with prior MI s/p stent to RCA (2008), hypertension, dyslipidemia, and diabetes presented with acute onset of chest pain. Around 15:00 while at work he developed left-sided chest tightness that lasted for a few hours, then eventually went away, but returned the same evening around 22:00 when it woke him from sleep. He reportedly tried to “walk it off” which relieved the pain transiently. When the pain returned it was more severe and assoc...
Source: Dr. Smith's ECG Blog - July 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Cardiology MCQs
Modified Blalock-Taussig shunt is:
End to side anastomosis of subclavian artery to a pulmonary artery
Side to side anastomosis of main pulmonary artery to aorta
Side to side anastomosis of subclavian artery to a pulmonary artery using a conduit
Anastomosis of superior vena cava to right pulmonary artery
Correct answer: 3. Side to side anastomosis of subclavian artery to a pulmonary artery using a conduit
In classic Blalock-Taussig shunt, the subclavian artery is divided and anastomosed to the pulmonary artery as an end to side anastomosis. In modified Blalock – Taussig shunt, a Gore – Tex graft is used to connect th...
Source: Cardiophile MD - July 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Right ventricular infarction
Right ventricular infarction can be associated with inferior wall infarction. It is due to occlusion of the right ventricular branches of the right coronary artery. The actual prevalence of right ventricular infarction may be underestimated because right sided chest leads are not part of routine 12 lead ECG. In a study which included right sided chest leads V3R, V4R, V5R and V6R, ST elevation of 1 mm or more in any of these leads was found to be a reliable sign of right ventricular involvement. It was a study of 67 patients who underwent serial electrocardiograms and 99mtechnetium pyrophosphate scintigraphy and a dynamic ...
Source: Cardiophile MD - June 25, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
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
Identification of culprit vessel from ECG
Identification of culprit vessel or infarct artery localization from ECG is useful during primary angioplasty. The initial diagnostic angiogram shot is taken in the artery which is not the culprit vessel, with a diagnostic catheter. Guide catheter is used for diagnostic shot in the suspected culprit vessel after that. This saves time during primary angioplasty.
Have a look at the ECG below:
Inferior wall infarction
It shows show ST segment elevation in leads II, III and aVF of about 3mm. ST segment depression is seen in leads I, aVL and V1 to V5. Overall features are suggestive of hyperacute phase of inferior wall myocard...
Source: Cardiophile MD - June 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Cardiology ECG / Electrophysiology ECG Library Source Type: blogs
A man in his 50s with schizophrenia, hypoglycemia, and vague chest pain and shortness of breath for a few days
Written by Pendell Meyers with edits by Steve SmithBystanders called EMS for a man in his 50s " not acting right. " Medics found a man with altered mental status, immediately measured a blood glucose of 42 ng/mL, and administered glucose. There was immediate improvement in his mentation, but it was " not back to normal. " Now that the patient was able to give some history, he was able to complain of chest pain and shortness of breath off an on for " a few days. " The impression that I get from the documentation is that the patient was still felt to be somewhat altered, and the history was felt to be somewhat unr...
Source: Dr. Smith's ECG Blog - May 30, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
PerQseal+ for Large Diameter Arterial Closure: Interview with Andrew Glass, CEO of Vivasure Medical
Vivasure Medical, a medtech company based in Galway, Ireland, has developed the PerQseal device, a synthetic implant designed to seal large bore blood vessel punctures. The implant has utility in a wide variety of transcatheter endovascular procedures, such as transcatheter aortic valve replacement (TAVR), thoracic endovascular aneurysm repair (TEVAR), and endovascular abdominal aneurysm repair (EVAR), and aims to significantly improve on current approaches to close large vessel punctures.
The implant is an intravascular patch that is applied to the puncture from inside the vessel and is fully absorbable. The patch does...
Source: Medgadget - May 26, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Cardiology Exclusive Radiology Vascular Surgery Vivasure Source Type: blogs
Atrial Fibrillation w Rapid Ventricular Response and ST Depression Maximal V1-V4: Not always subendocardial.
A patient presented a few years ago with chest pain, but also cough, low grade fever, and malaise. She had one prehospital saturation at 88%, but otherwise all vital signs and labs were normal, without tachycardia, elevated BP or anemia. She was never in any distress.She had this prehospital ECG:What do you think?There is diffuse ST depression, in I, II, III, aVF and V3-V6. It is diagnostic of ischemia. It is maximal in V5 and II, with reciprocal STE in aVR, and is thus most consistent with subnendocardial ischemia (Posterior OMI would have maximal STD in V1-V4, and Posterolateral OMI would have STD...
Source: Dr. Smith's ECG Blog - May 25, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 30s with greater than 12 hours of chest pain
Written by Bobby Nicholson MD, with edits by MeyersA man in his early 30s presented at 7:35am to the ED with chest pain (7/10) beginning suddenly at 7:30pm the night prior. The note did not specify whether the pain had been truly constant for 12 hours, or whether it had been intermittent. He had associated nausea, vomiting, hot flashes, chills, dyspnea, and cough. He had uncontrolled type 1 diabetes and smoking history. Vitals were normal. Physical exam was unremarkable. No prior ECG was on file.At 0742, this ECG was obtained in triage:What do you think?Raw Findings: - Sinus rhythm - QRS is narrow wit...
Source: Dr. Smith's ECG Blog - May 7, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
See this: Occlusion/Reperfusion/Re-occlusion/Reperfusion/Re-occlusion/Reperfusion
A 60-something y.o. male presented with intermittent left-sided chest and shoulder pain that is achy in nature and lasted a few minutes or sometimes just a few seconds. " The symptoms come and go, not associated with any exertion or history of trauma. Patient does have a history of hypertension and has been taking his medications. Prehospital EKGs appeared consistent with anterior tombstone ST elevation with pain. " Prior to arrival the patient was given full dose aspirin, as well as nitroglycerin, which relieved his pain, after which T wave inversions were noted in the anterior precordial leads.&...
Source: Dr. Smith's ECG Blog - May 3, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
It ’s OK to Break the Rules Now and Then
This study introduces an augmented intelligence platform for the real-time synthesis of institutional knowledge captured in EHRs.” One caveat that the researchers acknowledge in the report was that they had yet to conduct prospective validation of the augmented EHR curation approach.A second nference-based investigation reviewed the records of patients who had received more than 94,000 doses of the Pfizer COVID-19 vaccine, more than 36,000 doses of the Moderna vaccine, and 1,745 doses of the Johnson& Johnson vaccine. The study ’s goal was to determine the incidence of cerebral venous sinus thrombosis (CVST), w...
Source: Life as a Healthcare CIO - April 26, 2021 Category: Information Technology 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
