The assessment of venous thromboembolism risks associated with pregnancy and the postnatal period
This report finds that pregnant people could suffer a potentially fatal blood vessel blockage if their risk is not properly assessed during pregnancy and the first six weeks after birth. It aims to identify factors that limit the effectiveness of venous thromboembolism risk assessment policies and identify opportunities to improve patient safety.ReportHealthcare Safety Investigation Branch - news (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - December 8, 2022 Category: UK Health Authors: The King ' s Fund Library Tags: Patient safety Source Type: blogs
Potential disadvantages of perioperative heparin bridging
Some of the potential disadvantages of perioperative heparin bridging are risk of thromboembolism due to subtherapeutic dose, more prolonged total hospital stay and cost as well as inconvenience of heparin therapy.
In addition to this, there can be excessive bleeding during re-initiation of warfarin with heparin overlap. Hence continuing warfarin through the procedure is becoming standard of care in certain special instances. This is more applicable to procedures with relatively low bleeding risk in those with high risk of thromboembolism. Cataract surgery under topical anesthesia is one such potential situation in which ...
Source: Cardiophile MD - December 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the best treatment option for prosthetic valve thrombosis presenting with stroke?
In patients having prosthetic valve thrombosis presenting with stroke, surgery is the first option as thrombolysis is contraindicated. Surgical treatment has a combined risk of death or stroke of 9%.
For prosthetic valve thrombosis without stroke:
If the thrombus in the prosthetic valve is less than 5 mm in size, only intravenous heparin is recommended. For larger thrombi there are two options: thrombolysis versus surgical treatment.
Thrombolysis has an initial success rate of 70 -80%, but there is a 5 -22% risk of embolism, and 5 -12% risk of disabling stroke. Thrombolysis is the preferred treatment ...
Source: Cardiophile MD - December 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said " Nothing too exciting. "
This article fails to specify whether it was troponin I or T, but I contacted the institution and they used exclusively troponin I during that time period.Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. The impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy. J Electrocardiol [Internet] 2022;Available from: http://dx.doi.org/10.1016/j.jelectrocard.2022.09.009Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%)V Fib Cardiac arrestProlonged QTCNSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different)Moderate sin...
Source: Dr. Smith's ECG Blog - November 30, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Importance of cardiac imaging in patients with ventricular tachycardia
Late gadolinium enhancement on cardiac magnetic resonance imaging identifies scars likely to cause reentrant ventricular tachycardia. Ischemic scars are predominantly subendocardial while post inflammatory scars are predominantly sub epicardial. Scar in dilated cardiomyopathy is located in the mid wall region.
Imaging data is thus useful in deciding on the access (endocardial or epicardial approach) for ablation of ventricular tachycardia. Imaging will also tell us whether there is pericardial calcification which may interfere with catheter navigation in pericardial space in case of epicardial ablation. Similarly presence...
Source: Cardiophile MD - November 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Door in – Door Out Time?
What is Door in – Door Out Time?
Door in door out time is applicable when a person presents with ST segment elevation myocardial infarction to a centre which does not have the facility to perform primary angioplasty by percutaneous coronary intervention or PCI.
Recommended door in – door out time in ST elevation myocardial infarction presenting to non-PCI capable center is less than 30 minutes. Primary angioplasty being the best option to open up the infarct related coronary artery, it has to be done at the earliest. So time should not be lost by undue observation at a non PCI capable centre. When the person presen...
Source: Cardiophile MD - November 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?
A 30-something male was involved in a single vehicle crash and had multiple injuries. As a routine part of his critical trauma evaluation, he had an ECG recorded:There is an rSR " in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy. I was shown this ECG and thought that it could perhaps be Brugada, butI was more suspicious for Right Ventricular (RV) myocardial contusion. The RV is the most anterior part of the chest and is most likely to be contused with anterior chest trauma. Moreover, this degree of ST Elevation is very unusual for B...
Source: Dr. Smith's ECG Blog - November 25, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
What is the commonest sustained arrhythmia in HCM?
Commonest sustained arrhythmia in hypertrophic cardiomyopathy is atrial fibrillation. Atrial fibrillation (AF) can occur in about 1/5th of cases of hypertrophic cardiomyopathy (HCM). Factors predisposing to AF in HCM are left atrial pressure and size due to left ventricular diastolic dysfunction, left ventricular outflow tract obstruction and mitral regurgitation. About one fourth of them may develop embolic episodes and stroke. It has been suggested that those with left atrial diameter of 45 mm or more should undergo 48 hour Holter once or twice a year to look for AF. Anticoagulation is recommended in those with AF ...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Airway hemorrhage in Eisenmenger syndrome
In Eisenmenger syndrome airway hemorrhages have to be thought of specially when moving from lower to a higher altitude as during air travel or while ascending a mountain. Hemoptysis has been reported as a cause of death in Eisenmenger syndrome in 11-29% [1].
Defects in hemostatic mechanism due to abnormal platelet function, thrombocytopenia, deficiencies of clotting factor as well as depletion of von Willebrand factor may also contribute to airway hemorrhages in Eisenmenger syndrome [2].
References
Jensen AS, Iversen K, Vejlstrup NG, Sondergaard L. Pulmonary artery thrombosis and hemoptysis in Eisenmenger syndrome. ...
Source: Cardiophile MD - November 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the most common cause of acquired heart disease in children in developed countries?
Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. In developing countries it will be rheumatic heart disease.
Timely treatment of Kawasaki disease with intravenous immunoglobulin can reduce the incidence of coronary aneurysms from 25% to around 4%. Children with coronary aneurysms due to Kawasaki disease needs lifelong cardiology follow up. The prognosis depends on the initial and current level of coronary involvement. Some children may develop coronary obstruction and thrombosis leading to myocardial infarction. Revascularization procedures may be needed in some of th...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What Is Blood Anyway?
A few years ago I had a great opportunity to write an article series for EMS Magazine called Blood On Tap. It was all about the pioneering work being done by different pharmaceutical groups to create artificial substitutes for blood.
The technical name for the pharmaceutical products that mimic the properties of blood is “oxygen therapeutics.” Here’s the inside scoop, directly from the drug company big wigs, on why we don’t call them something cool like artificial blood.
The thing is, the drug company’s know full well that these fancy solutions are nowhere near advanced enough to mimic the many complex...
Source: The EMT Spot - November 10, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT Source Type: blogs
What is atrial flutter? Cardiology Basics
Atrial flutter is a fast and organized arrhythmia originating from the atria. In this way it is different from the commoner atrial fibrillation which is quite fast but irregular rhythm originating from the atria. It shares the risk of thrombus formation in the atria and needs anticoagulants, like atrial fibrillation. Atrial flutter commonly arises from the right atrium. It can also arise from the left atrium sometimes.
Though the atrial rate is typically around 300/minute, the whole of it does not get conducted to the ventricles. The AV node reduces the number of impulses conducted to the ventricles. When there is only 2:...
Source: Cardiophile MD - October 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is PT-INR monitoring? Cardiology Basics
INR is short for International Normalized Ratio of Prothrombin Time. It is also called PT-INR. The INR monitoring is used to monitor the dosage of vitamin K antagonists like warfarin. Vitamin K antagonists are used for stroke prevention in atrial fibrillation as well as for deep vein thrombosis and pulmonary embolism. Non vitamin K oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban and apixaban do not need INR monitoring. Warfarin is routinely used when there is a mechanical prosthetic valve, to prevent valve thrombosis and thromboembolism. As of now, DOACs are not i...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can dark chocolates keep heart disease away? Cardiology Basics
A study published in ‘Circulation’ – the flagship journal of American Heart Association, suggested that eating dark chocolate can decrease your risk for myocardial infarction.
Myocardial infarction is usually due to a coronary obstruction, though there are other varieties as well, according to the Universal Definition of Myocardial Infarction. High oxidative stress and limited availability of antioxidants can cause endothelial damage in the arteries, leading to increased chances for a thrombosis.
Dark chocolates (which contain 70% cocoa) have lots of flavonoids – potent antioxidants which helps to overcome the oxi...
Source: Cardiophile MD - October 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is an implantable cardioverter defibrillator (ICD)? Cardiology Basics
Implantable cardioverter defibrillator or ICD is a cardiac implantable electronic device or CIED. The device is implanted subcutaneously under local anaesthesia, usually below the left clavicle. The electrodes from the device are introduced into the right sided cardiac chambers through a subclavian vein puncture. The ICD senses and analyzes heart rhythm continuously. It can detect life threatening ventricular arrhythmias and treat them electrically.
If a ventricular tachycardia is detected, the ICD tries to overdrive it by fast pacing. If it does not suppress the ventricular tachycardia, the ICD delivers a shock through i...
Source: Cardiophile MD - October 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
