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
How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !
The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC ...
Source: Dr.S.Venkatesan MD - March 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs
Special circumstances where warfarin is favored over DOACs
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - January 21, 2024 Category: Internal Medicine Tags: cardiovascular hematology hospital medicine pharmacology Source Type: blogs
Chronic stable AF on warfarin: Don ’ t DOAC them just like that!
Are you still on warfarin? Come on, switch to DOAC./NOAC This seems to be a fashion statement among cardiologists and their patients with chronic AF. (By the way, NOAC has a new name, i.e., DOAC. NOAC stands for non-vitamin K anticoagulants. Now, N is replaced with D, direct-acting oral anticoagulants.)
NOAC does have some advantages. the major one is better patient compliance, and ease of administration as it doesn’t need routine monitoring. (One may wonder how this transforms into a real advantage? ) The drug acts in a dark invisible mode. Bleeding risks are either less, equivocal, or high. So we can’t con...
Source: Dr.S.Venkatesan MD - October 12, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized apixaban doac factor xa antagonist noac noac for atrial fibrillation oac vs noac swtiching to noac from warfarin warfarin vs noac Source Type: blogs
Blood Pressure Meds vs Blood Thinners: What ’ s The Difference?
Conclusion
In conclusion, while blood pressure medicines and blood thinners are both crucial to heart health, their roles and mechanisms of action are notably distinct. Blood pressure medication works primarily on the vascular system, aiding in reducing blood pressure by relaxing blood vessels or altering the heart’s function. On the other hand, blood thinners target the blood itself, working to prevent the formation of potentially dangerous blood clots.
Throughout this article, one thing becomes undeniably clear: the importance of regular consultations with your healthcare provider. When it comes to managing m...
Source: The EMT Spot - July 20, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure 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
Non-vitamin K antagonist oral anticoagulants (NOACs) and valvular heart disease with AF
Subgroup analysis of certain clinical trials support the use of rivaroxaban, apixaban, dabigatran and edoxaban in patients with aortic stenosis, aortic regurgitation or mitral regurgitation having atrial fibrillation. NOACs can also be used in aortic bioprosthesis with atrial fibrillation if the valve has been implanted more than 3 months back.
NOACs are better avoided in those with moderate or severe mitral stenosis and atrial fibrillation in view of high thromboembolic risk. NOACs should not be used in those with mechanical prosthetic valve with or without atrial fibrillation. Those patients still require vitamin K anta...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
6 Techniques To Nail The IV Every Time
Did you get the IV?
Sometimes it seems like your performance on the whole call can be reduced to the success or failure of the IV start. Rarely does the successful treatment of the patient hinge on a successful IV placement but sometimes it can certainly feel that way.
The best way to ensure that you’re ready when that make or break it IV start does come your way is to start a lot of them when the pressure is not on. If you wait until game day to practice, you’re a whole lot more likely to fail.
The single biggest factor that separates the IV virtuoso from the weekend hacker is practice and experience, so when...
Source: The EMT Spot - November 1, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT 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
How is pulmonary embolism treated? Cardiology Basics
Pulmonary embolism is obstruction of pulmonary arteries due to emboli migrating from other parts of the body. It is a potentially life threatening condition if a major branch or multiple branches are obstructed. More emboli can travel to the lungs from the original source and hence pulmonary embolism may worsen later even if the initial episode involves only a small portion of the lungs. So, it is important to treat pulmonary embolism even if it is mild. Treatment options will depend on the severity of the situation.
Initial treatment will be with parenteral anticoagulants like heparin or low molecular weight heparin. Aft...
Source: Cardiophile MD - October 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Little Stories on a Medical Librarian ’ s Impact
I want to thank the many people who have shared some of their impact stories. I thought I would post these as little vignettes to serve as a sort of “Chicken Soup for the Librarian’s Soul.” While these stories may short, the impact of the medical librarian is not.
All stories are told in the first person. They are not my stories, they are the stories from the emails librarians have sent me.
_____________________
I bumped into a nurse who I was doing research for the other day. She thanked me for all of the work I did on INR (international normalize ratio) levels and Coumadin in patients with Cov...
Source: The Krafty Librarian - October 5, 2022 Category: Databases & Libraries Authors: KraftyLibrarian Tags: Uncategorized Source Type: blogs
A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 30s with chest pain and a normal bedside echo, without wall motion abnormality
In conclusion — our THANKS to Drs. Nicacio and Meyers for presenting today ' s case. As interesting as I found the initial ECG to be — the KEY point in today ' s case is that identification of suspicious (albeit indefinite) ECG findings in this patient with typical unrelieved chest pain merited timely cath (which was done within 15 minutes of ED presentation) — and this confirmed the need for prompt revascularization. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 17, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Blood Clotting Test on a Smartphone
Researchers at the University of Washington have developed smartphone-based technology that can allow someone to perform a blood clotting test at home. The technology is low-cost and easy to use. The test involves placing a drop of blood into a plastic attachment that can be viewed by a smartphone camera. The smartphone then vibrates the blood, and the camera can detect when the blood has clotted. The approach provides an inexpensive and convenient blood testing option for patients who are taking anti-coagulants.
Anti-coagulants, such as warfarin, provide a measure of security against blood clots for a variety of patien...
Source: Medgadget - February 22, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Diagnostics Medicine universityofwashington Source Type: blogs
