CABG is the most common cardiovascular surgery done world wide . When the ventricle is dilated it is a common practice to do a ventricular reduction surgery. It was a logical to expect benefit when we correct the adverse remodelling of heart that aoccur following an MI. The STICH trial compared plain CABG with ventricular [...]
Archive for March, 2009
A STICH in time do not save nine !
Posted in cardiac surgery, Cardiology - Clinical, Cardiology -Interventional -PCI, tagged annals of thoracic surgery, cabg, dor procedure, STICH Hypothesis, STICH TRIAL, ventricualr reconstruction surgery, ventricualr reduction surgery on March 31, 2009 | Leave a Comment »
Can coronary collaterals provide more blood flow than a CABG ?
Posted in Uncategorized, tagged cabg, coronary collateral, coronary collateral circulation, courage, cto, LAD, lad 100%, lad stump, oat, pci, pda, rca to lad, toal lad on March 29, 2009 | Leave a Comment »
Coronary collateral circulation is the most poorly understood, and often neglected concept among the cardiology community.There is a general perception , in obstructive CAD , coronary collaterals are an inferior modality of back up blood supply than artificial collateral (Also called CABG ) ! One of the reasons, it is been ridiculed by many mainstream [...]
Why many of the coronary perforations during PCI are benign ?
Posted in Cardiology -Interventional -PCI, Uncategorized, tagged cardaic tamponadew, coroanry perforation, coronary guidewire, dissection, epicardail perforation, europcr, false lumen, freed, gruentzig, jacc, manual of interventional cardiology, pci, pseudo science, ptca, scai, tctmd, tissue palne on March 28, 2009 | Leave a Comment »
Coronary artery perforation is a dreaded complication of PCI. Perforations are the Interventional cardiologists ultimate worry as they need to manipulate their hardware for long periods in many complex lesions. Especially it is a real threat in chronic total occlusions. Still , an important fact is , many of the coronary perforations are not [...]
Can hand steal blood from the heart ?
Posted in cardiac surgery, Cardiology - Clinical, tagged cabg, coronary subcalvian dtal, lima, reversal of lima flow, subcalvian stenosis on March 27, 2009 | Leave a Comment »
CAD is the major cardiovascular disease of our population. CABG is the most common cardiac surgery done world over. LIMA to LAD graft is the most common by pass done. The purpose is to short circuit some of the blood meant for the hand to the heart. But , is it always a helping hand [...]
And now , a biochemical diagnosis for pulmonary hypertension !
Posted in cardiology -congenital heart disease, tagged 100% oxygen, asd, bi directional shunt, biochemical diagnosi of pulmonary hypertension, eisenmengersyndrome, heath edwards, nitric oxide, pd, pht, reversibility of pulmonary hypertension, right to left shunt, severe pulmonary hypertenison, tolazoline, vsd on March 27, 2009 | Leave a Comment »
Biochemical diagnosis for PHT and Eisenmenger syndrome Identifying reversibility of pulmonary arterial hypertension remains a difficult clinical problem.Heath edwards grading of pulmonary hypertension is based on lung pathology .Grade 4 and 5 constitute severe obstructive vascular pathology including pulmonary vascular necrosis. Lung biopsy is an invasive procedure and has a huge risk in patients with [...]
What are the advantages or disadvantages of having a short or long left main coronary artery ?
Posted in Uncategorized, tagged left main artery on March 26, 2009 | Leave a Comment »
Left main coronary artery disease is a major form of CAD . A long left main by virtue of it’s surface area statistically , are more prone for atherosclerosis as it preferentially affect the proximal vessel.A long and tubular leftmain generally give the LCX branch at right angles(In the above pateint it is 90*).This [...]
Land mark papers in cardiology : Beta blockers in cardiac failure .The power of simple observation far exceeds the synthesised evidence
Posted in cardiology -Therapeutics, cardiology-ethics, Cardiology-Land mark studies, Uncategorized, tagged beta blockers in cardiac failure, carvidilol, cibis, comet, copernicus, f.waagstein, metoprolol, observational study, practolol, randomised control trials, statistics on March 26, 2009 | Leave a Comment »
Beta blocker use in cardiac failure has come a full circle from a “contraindication to indication” You don’t need gimmicks of statistics for science to progress. What you require is meticulous observation. F .Waagstein of Sweden just did this with a study population of seven patients . This land mark study , was least [...]
What is the difference between dopamine and dobutamine and what is the clinical significance ?
Posted in cardiac drugs, Cardiology - Clinical, cardiology -Therapeutics, tagged adrenergic receptors, cardaic pharmocology, cardiac failure, catecholamine, dobutamine, dopamine, dopaminergic receptors, inotrpic agents, ischemic lvf, lvedp and dobutamine, nor epinephrine, pcwp and dopamine, renal dopamine dose on March 25, 2009 | 3 Comments »
Dopamine and dobutamine are the most commonly used inotropic agents in clinical cardiology. The following table represents a simple comparison of the two drugs.
The Aortic dissection : What you wanted to know about true and false lumen !
Posted in cardiac surgery, Cardiology - Clinical, Cardiology -Interventional -PCI, Tutorial in clinical cardiology, tagged aortic band, aortic disscetion, aortic septum, cob webs in aorta, dissecting aneurysm of aorta, entry point in aorta, exit point in aorta, falp curvature, false lumen, false lumen of aorta, mri of aorta, stents for aortic aneurysm, tendrils, trans esophageal echocardiography, true lumen, true lumen of aorta, type a debaky, vinculum on March 24, 2009 | Leave a Comment »
Why is identifying false and true lumen important ? This helps the interventional cardiologist to plan the specific therapeutic procedure . Is it really difficult to differentiate the two ? One may wonder , why is that difficult to identify the true aortic lumen by echo, after all , the LV empties the blood into [...]
What are the precautions to be taken during PCI when we encounter thrombus containing lesions ?
Posted in Cardiology -Interventional -PCI, cardiology -Therapeutics, tagged 2b 3a antagonists, acs, coronary dead space, coronary thrombosis, distal protection, drug eluting stent, expoert catheter, freed, ivus, pci, pci and thrombus, primary pci, ptca, stent approximation, tct md, thrombus and pci on March 22, 2009 | Leave a Comment »
First and foremost is Avoid the procedure if not really indicated.A lesion which has more thrombus load than a plaque and it is , subcritical and not limiting the flow , PCI may be inappropriate especially if the ACS is stabilised. Adequate anticoagulation along with 2b 3a blockers should be used Predilatation should be minimally [...]
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