Aortic erosion following ASD device closure : A reality check !
ASD device closure has become a de-facto modality for most ostium secundum defects(<35mm). The stupendous success of this procedure is attributed to careful pre and Intra-procedural Imaging, new generation hardware and of course the ever-improving expertise among Interventional cardiologists.
Still, there is one issue that is bothersome. It is the late complications of this device and the need for follow-up (Unlike surgery where close and forget option seems real and confer lot of comforts) The delayed mechanical complications are now extremely rare still follow up of these patients is advised.
What is the mechanism o...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd device closure and aortic erosion atrial septal defect closure by amplatzer ias dynamics late migration of asd device mechanism of of aortic erosion surgery vs device asd closure transverse sinus pericardium effuion ias asd Source Type: blogs
Fight Aging! Newsletter, March 22nd 2021
This article expresses sentiments regarding medical technology and human longevity that we'd all like to see more of in the mainstream media. At some point, it will come to be seen by the average person as basically sensible to work towards minimizing the tide of suffering and death caused aging and age-related disease. It has been, in hindsight, a strange thing to live in a world in which most people were reflexively opposed to that goal.
Death and aging constitute a mystery. Some of us die more quickly. We often ask about it as children, deny it in youth, and reluctantly come to accept it as adults. Aging is uni...
Source: Fight Aging! - March 21, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Immunoglobulin-M Antibodies Reduce Risk of Thrombosis by Binding to Extracellular Vesicles that Induce Coagulation
Researchers have in the past found that low levels of immunoglobulin-M antibodies correlate with an increased risk of thrombosis, the blockage of a blood vessel by, for example, fragments of a ruptured atherosclerotic plaque. Here, more details regarding this relationship are reported, suggesting that therapies designed to increase immunoglobulin-M antibody levels could be useful in reducing the incidence of heart attack and stroke resulting from thrombosis.
Antibodies are an important component of the immune system. On the one hand, these proteins serve in the body to defend against microbes, and on the other han...
Source: Fight Aging! - March 16, 2021 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
D-dimer levels in normal pregnancy : Learnt something Important recently !
Have we ever wondered how six liters of blood in our body flows like a live stream, maintaining the fluidity life long, in spite of an active coagulation system in situ, ready to freeze at the slightest provocation (Invisible vascular wear & tear!) This housekeeping job, within the vast network of the human vascular tree, is silently accomplished by a less apparent system called fibrinolytic system. D-dimer is a physiological breakdown product of this system . D-dimer comes from fibrin monomer. The D in D-dimer stands for the domain. (See below) The ability to detect the D-dimer in the bedside has given us a good oppor...
Source: Dr.S.Venkatesan MD - March 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease fdp vs d dimer pulmonary embolism dvt in pregnancy what is the normal d dimer in pregnancy Source Type: blogs
Elevated prosthetic valve gradients
Elevated gradients across prosthetic valves can occur due to various reasons. But before declaring that prosthetic valve gradients are elevated, the usual gradient across the given type of prosthetic valve should be known. Different types of normally functioning prosthetic heart valves have different gradients. Normal gradient is different between the various valve positions. Transmitral prosthetic valve gradient is lower than transaortic prosthetic valve gradient. If the gradient during post operative review is available, it can be used as a benchmark for comparison.
Some of the important causes for elevated prosthetic ...
Source: Cardiophile MD - February 27, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Echocardiography Source Type: blogs
When there is less than 1 mm of ST depression, can you make the diagnosis of posterior OMI?
DiscussionApproximately 10% of OMIs will involve the posterior wall, most of which also have concomitant involvement of the lateral and/or inferior walls (though usually not meeting STEMI criteria). Isolated posterior OMI, however, manifests as STD without associated STE since the subepicardial myocardial ischemia that would normally generate STE on overlying leads is occurring in the opposing or negative vector compared to the recording ECG leads. The majority of isolated posterior OMIs will be due to occlusion of the LCX, RCA, or a variety of their posterior branches.The 4th Universal Definition of Myocardial Infarc...
Source: Dr. Smith's ECG Blog - February 27, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Saw this ECG while reading through a stack. Lots here: myocardial stunning, MRI viability, P2Y12 inhibitors and CABG.
I had just finished passing the shift off to my partner and the next shift of residents. It was 11:30 PM. I turned to the computer system to finish reading any EKGs from the shift and I saw this one, which had been recorded after the end of my shift at 11:11.Usually these are brought immediately by the tech to the faculty physician. I ' m not certain whether another faculty had seen this or not.What do you think?I immediately saw the ST depression in V2 and V3 of at least 1.5 mm. There is also minimal STD in II, III, aVF. When you see this inferior STD, you should not think " in...
Source: Dr. Smith's ECG Blog - February 26, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Giant T inversion and NSVT
Giant T inversion with NSVT
Holter tracing showing giant T wave inversion and non sustained ventricular tachycardia, both at the beginning of the tracing and at the end. Ventricular ectopic beats are also seen in between. Variation in QRS amplitude of the NSVT beats are evident. It is likely that this will soon progress to torsades des pointes in the setting of gross QT interval prolongation. QT interval is seen as 640 ms in a cycle with cycle length of 600 ms. So, the QTc will be 640 ms. The first ventricular ectopic is followed by a good compensatory pause while the second one is almost an interpolated ventricular ecto...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
Mobile right heart thrombus : Capture by Flowtriever device is possible
What shall we do when encountering a mobile right heart thrombi waiting to get dislodged at any time?
A series of question comes as the answer to this query
Feeling helpless? What will be the consequence?Massive pulmonary embolism? Can we thrombolyse and dissolve it ?
Logistics of emergency open-heart surgery are too many. What about capturing the thrombus? A dream thought, now seemingly possible.Inari Flowtriever though made originally for pulmonary embolism can come in handy in any foreign body removal. I think It is approved by FDA. Here is a case report from Dr Gautam reddy.
Echo...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: New hardware pulmonary embolism Inari flow triever mobile ra rv clot Source Type: blogs
A man in his early 40s with chest pain: STD in V1-V4, but posterior lead are negative
This study by Shah et al. shows that the STD of subendocardial ischemia (in contrast to posterior OMI) is maximal in V5 and V6.Shah A, Wagner GS, Green CL, et al. Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies. Am J Cardiol [Internet] 1997;80(4):512 –3. Available from: https://europepmc.org/article/med/9285669However, STD in V1-V4 can occasionally be due to subendocardial ischemia. If posterior leads also show ST depression, then subendocardial ischemia is probable!!&...
Source: Dr. Smith's ECG Blog - February 14, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Fully Implantable LVAD for End-Stage Heart Failure: Interview with Greg S. Aber, CEO of Corvion
Patients with advanced heart failure often need a cardiac transplant due to the severe injuries sustained by the heart muscle.
Left Ventricular Assist Devices (LVADs) are frequently used in such patients to help the heart pump blood through the body while they are waiting for a transplant. These devices are also used in the short-term to support the hearts of patients who have had heart surgery, and are increasingly being employed as a long-term option for patients who cannot get a transplant.
Medgadget had an opportunity to speak to the Greg Aber, CEO of Corvion Inc., a company that has developed a fully implantab...
Source: Medgadget - February 12, 2021 Category: Medical Devices Authors: Rukmani Sridharan Tags: Cardiac Surgery Cardiology Exclusive Source Type: blogs
Wellens' syndrome: to stent or not? IVUS negative, Symptoms persist, Stress Testing, Instantaneous Wave Free Ratio, and Fractional Flow Reserve.
A 55 y.o. male with no cardiac PMHX presented for 2 weeks of exertional chest pain, worsened on the day prior to presentation. On the day of presentation, the chest discomfort was particularly intense, and associated with diaphoresis and nausea. It was resolved (pain free) when the ECG was recorded:This ECG was read as " nonspecific " by the providers. What do you think?These is classic Wellens ' pattern A (biphasic, terminal T-wave inversion), and it isWellens 'syndrome (Angina, resolved -- pain free -- with preserved R-waves and Wellens ' pattern A T-waves). The morphology of these T-wav...
Source: Dr. Smith's ECG Blog - January 28, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Acute Chest pain which then resolves spontaneously
A 50-something woman presented with sudden onset of left sided chest pain while driving, radiating down left arm, in addition to feeling diaphoretic, dizzy, and lightheaded. She presented immediately to the ED and had this ECG recorded:QTc was 432 msWhat do you think? One of our fellows and a resident were worried about the ST Elevation in V3-V5, and but they were uncertain if it was possibly normal variant STE.They calculated the formula at21.05, which very strongly suggests acute LAD occlusion. 18.2 is the most accurate cutoff value, but at 19.0 it is very very specific. 21.05 is nearly always ...
Source: Dr. Smith's ECG Blog - January 23, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Acute chest pain, ST Depression in V2 and V3, relief with Nitroglycerine, " normal " coronaries, and apical ballooning. Is it takotsubo?
This was submitted by Michael Fischer, one of our outstanding2nd year EM residents at Hennepin Healthcare.CaseA previously healthy female in her 40s presented 1 hour after abrupt onset 10/10 crushing chest pain that started while brushing her hair that morning. The pain radiated to her bilateral jaw and right shoulder, and did not seem to be exertional or pleuritic in nature. Here is her pre-hospital ECG: What do you think?Smith: V2 and V3 have some minimal ST depression with downsloping. This is highly suggestive of posterior MI.This was read by EMS as non-specific. Aspirin 324mg was given by EMS. Ni...
Source: Dr. Smith's ECG Blog - January 8, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Innovation in pediatric Interventions: Device closure of sinus venosus ASD is not forbidden
Embryology
Sinus venosus ASD (also referred to as SVC ASD) is a defect in the failure of the sinoatrial orifice to lateralize completely to the right side during atrial septation.Left venous valve, as well as the septum secundum, fails to fuse with the roof of the atria creating interatrial communication. During this process, the developing pulmonary vein overshoot to the right side making PAPVD a mandatory add-on defect. (Harley ,Thorax 1958 ) It can be referred to as embryonal venous migration defect at the level of RA. In the same sense, it is not a true defect in IAS but a defect in septation between SVC/P...
Source: Dr.S.Venkatesan MD - January 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized SINUS VENOSUS ASD stenting for svc asd SVC ASD device closure Source Type: blogs
