What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !)
What is an intermediate coronary lesion? (ICL)
Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any revascularisation debate).
Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet named th...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs
What's new in midwifery - 23rd April 2021
#whatsnewinmidwifery is a tag I shall use on Twitter (@knockels) if retweeting things of interest. Let ' s see how that goes.Some retweeted things may be in these blogposts as well.Here are some things you might need to know.COVID-19Pregnant women to be offered the vaccine.NewsIn the news, stories about thesix week check not looking at the health of the mother, abouthealth and safety at work and pregnancy, and perhapsan indication of your future workload!And a report aboutone consequence for women attending prenatal appointments alone.One woman ’s experience of postpartum psychosis, . And related,...
Source: Browsing - April 23, 2021 Category: Databases & Libraries Tags: midwifery Source Type: blogs
Non-compaction of left ventricle
Non-compaction of left ventricle is often classified as a cardiomyopathy and is characterized by abnormal deep trabeculations, which is more at the apex [1]. Left ventricular non-compaction can be associated with left ventricular dilatation or hypertrophy. Systolic and diastolic dysfunction can occur and other congenital heart diseases can be associated. Ventricular arrhythmias and complete atrioventricular block can occur and present as syncope or sudden cardiac death.
Genetic transmission has been noted in 30-50% of patients and several genes have been implicated. NOTCH signaling pathway seems to be the final common pa...
Source: Cardiophile MD - April 23, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
This is really good Prehospital, ED, and Cardiology care. Inferior de Winter's T-waves.
A 50-something y.o. male with history of previous acute MI and stent was shoveling snow. Shortly thereafter he had the onset of tight chest pain across the front of his chest, without radiation, but associated with diaphoresis and nausea without vomiting. It felt similar to his prior heart attack 9 years ago. He called EMS immediately. Here is his first prehospital ECG: What do you see?There is ST depression maximal in V3, and also in inferior leads. There is minimal T-wave inversion in aVL, by itself a soft sign of inferior MI. Are the T-waves large? Does this inferior ST depression ...
Source: Dr. Smith's ECG Blog - April 21, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fontan Circulation
Fontan repair of tricuspid atresia was initiated in late 1960s. Francis Fontan et al reported that surgical repair was carried out in three patients with tricuspid atresia of which two were successful [1]. Inferior venacaval blood was directed to the left lung and the right pulmonary artery received the superior venacaval blood through a cavopulmonary anastomosis. They mentioned that the size of the pulmonary arteries must be large enough and at sufficiently low pressure to allow flow in a cavopulmonary anastomosis.
The first step was a Glenn procedure in which distal end of right pulmonary artery was anastomosed to the ...
Source: Cardiophile MD - April 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs
This case was flagged as a false positive cath lab activation. Why? And do you agree?
Conclusions/Summary " Indication: Chest pain with dynamic EKG changes concerning for ACS "--CAD with moderate stenosis of ostial left main.--CAD with long segment of serial stenosis of proximal to mid LAD.--Successful PCI of proximal to mid LAD with placement of 3.5 x 38 and 3.5 xLAD: Large caliber vessel.There is a long segment of serial 50-80% stenosis noted in the mid portion of the vessel. The LAD is severely tortuous and there is large caliber diagonal after an acute bend in the mid vessel. The distal and apical segments are without significant stenosis. Lesion on Mid LAD was stented in a comp...
Source: Dr. Smith's ECG Blog - April 19, 2021 Category: Cardiology Authors: Steve Smith 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
Basic info on the J & J vaccine kerfuffle
I ' ve seen a lot of chatter to the effect that the FDA/CDC advise to pause administration of the Johnson and Johnson vaccine is ignorant, counterproductive, foolish and contrary to the public interest. The same reaction followed when many countries in the EU halted administration of the AstraZeneca vaccine, accusing the authorities of succumbing to thepost hoc, ergo propter hoc fallacy. Well no. There is a legitimate debate about whether this was an overreaction, I suppose, but it isn ' t simple.Here ' s a good summary of the issues. It isn ' t as simple as saying there have been six cases of the adverse effect --cerebral...
Source: Stayin' Alive - April 14, 2021 Category: American Health Source Type: blogs
Does J & J ’s Covid‐19 Vaccine Pose Fewer Risks than Oral Contraceptives?
Michael F. CannonEarlier today, I wrote about the U.S. Food and Drug Administration ’srecommendation that federal and state governments stop administering Johnson& Johnson ’s Covid‐19 vaccine because the agency was “reviewing data involving six reported U.S. cases of a rare and severe type of blood clot …called cerebral venous sinus thrombosis (CVST).” Here, I thought I would do a back ‐of‐the‐envelope comparison of this risk to that of another category of products on which the FDA has not placed a hold: oral contraceptives.According to oneliterature revi...
Source: Cato-at-liberty - April 13, 2021 Category: American Health Authors: Michael F. Cannon Source Type: blogs
Johnson & Johnson vaccine suspension: What this means for you
What is this potential side effect of the J&J vaccine for COVID-19? The potential side effect is a blood clot in the veins that drain blood from the brain. This is called central venous sinus thrombosis. In the vaccine-associated cases of this, platelets in blood, which are important for making clots, have been lower than […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 13, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/william-petri" rel="tag" > William Petri, MD, PhD < /a > < /span > Tags: Conditions COVID-19 coronavirus Infectious Disease Source Type: blogs
Rapid Compression Device to Prevent Deep Vein Thrombosis
Researchers at Penn Medicine have developed a wearable sleeve that provides rapid pulsatile compression, and aims to mimic the compression our calf muscles experience during walking. The technology, being commercialized by Osciflex, a spin out from Penn Medicine, is intended to prevent deep vein thrombosis in patients who are bed-bound for long periods of time.
Deep vein thrombosis tends to affect those that are not very mobile, so getting out of bed to stretch one’s legs is a challenge, making the condition tricky to prevent. At present, mechanical cuffs that periodically inflate around the leg are used, with mix...
Source: Medgadget - April 13, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Geriatrics Medicine Surgery Vascular Surgery 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
Getting It Right Despite the Wrong Paradigm
Written by Alex Bracey, edits by Meyers and SmithA 50 something year old male presented to the ED as a transfer from an outside hospital with chest pain. As EMS gave report I looked through the transfer packet for the initial ECG:Sinus bradycardia with loss of R-wave progression and hyperacute T-waves in V2-V5, slight STE in aVL and I without meeting STEMI criteria. There is a down-up T-wave in lead III, which is a very specific reciprocal finding in high lateral OMI. Very highly suspicious of OMI. Applying the 4-variable formula for detection of subtle anterior OMI would yield: STE60V3 = 2.5, QTc = 360, RV4 = 3, QRSV2 = 5...
Source: Dr. Smith's ECG Blog - April 12, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
COVID-vaccine induced thrombosis as explained by a hematologist
VIPIT is the medical term given to the phenomenon of developing clots in various parts of the body after certain (not all) COVID-19 vaccines. VIPIT stands for vaccine-induced prothrombotic immune thrombocytopenia, a complicated term explained simply as clotting of the thrombocytes or platelet cells in the blood vessels after receiving the COVID vaccine. Clearly, understanding […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 11, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/akshat-jain" rel="tag" > Akshat Jain, MD < /a > < /span > Tags: Conditions COVID-19 coronavirus Infectious Disease Source Type: blogs
Takayasu arteritis
Takayasu arteritis is an inflammatory disorder affecting aorta and its major branches. It is also known as aortoarteritis and pulseless disease [1]. Arteritis leads to thickening of vessel wall, fibrosis, stenosis and thrombus formation. Severe inflammation may weaken the arterial media and lead to aneurysm formation [2].
Takayasu was an ophthalmologist, who noted characteristic fundal arteriovenous anastomoses in a young female in 1905 and published it in Acta of the Opthalmic Society of Japan in 1908 (12:554–5). Onishi and Kagosha described similar cases associated with absent radial pulses in the same year [1]. ...
Source: Cardiophile MD - April 7, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
