Thrombolytic therapy , has been the specific treatment for STEMI for many decades. Primary PCI* is shown to be superior than thrombolysis if performed early by an experienced team in a dedicated facility. (*Conditions apply). It is estimated , currently only a a fraction STEMI population get primary PCI (<5%) in ideal [...]
Archive for May, 2009
What is dfference between successful thrombolysis and successful reperfusion in STEMI ?
Posted in Cardiology - Clinical, Cardiology -Interventional -PCI, Cardiology -unresolved questions, cardiology -ECG, cardiology -Therapeutics, tagged aivr, myocardial reperfusion, no reflow, nstemi, primary pci, reperfusion, reteplase, stemi, streptokinsae, successful reperfusion, successful thrombolysis, tenekteplase, thrombolysis, tpa, what is successful thrombolysis on May 27, 2009 | Leave a Comment »
What is ischemic left ventricular failure ?
Posted in Cardiology - Clinical, Cardiology -Interventional -PCI, Cardiology -unresolved questions, cardiology -Therapeutics, tagged stemi, nstemi, cardiac failure, pulmonary edema, ischemic lvf, left ventricualr failure, nstemi and lvf, nstemi and failure, stemi and lvf, stemi and cardiac failure, lv failure, myocardail failure, ischemic cardiogenic shock, ischeamic lvf, grace registry, flash edema on May 26, 2009 | 1 Comment »
Apart from acute coronary syndrome, cardiac failure is the most common clinical presentation of CAD. Cardiac failure , classically present with dyspnea on rest or on exertion , while angina is the dominant presentation in ACS.
What if , both these occur together in an acute fashion ?
Yes , if it occurs together [...]
Is there a time window for rescue PCI ? Why we are not insisting on it ?
Posted in Cardiology -Interventional -PCI, cardiology -ECG, cardiology -Therapeutics, tagged stemi, nstemi, thrombolysis, time window, cardiogenic shock, unstable angina, cto, tct md, europcr, scai, des, taxus, cypher, streptokinase, tpa, tnk tpa, no reflow, acute coronary syndrome, rescue angioplasty, rescue thrombolysis, rescue pci, rescue ptca, reteplase, tenekteplase, chronic total occulusion, reperfusion, timi flow, repeat thrombolysis, react trial, toat study, door to needle time, door to balloon time, door to pci, swit trial, jcc, what is rescue pci ?, what is recue angioplasty ? on May 25, 2009 | Leave a Comment »
Failed thrombolysis is an important clinical issue in STEMI as successful thrombolysis occurs only in about 50-60% of pateints . The typical criteria to define failed thrombolysis is the regression of less than 50% of sum total( or maximum) ST elevation in infarct leads.
So what do you do for these patients with failed thrombolysis [...]
Fallacies in emergency room :Why we are not risk stratifying STEMI on arrival , but do it promptly in NSTEMI ?
Posted in Cardiology -Interventional -PCI, Cardiology -unresolved questions, Cardiology-Coronary artery disese, cardiology -Therapeutics, tagged acc.aha, acute coronary syndrome, angina, anterior mi, cardiogenic shock, coronary care unit, emergency triaging of chestpain, high risk nstemi, high risk stemi, inferior mi, is there a low risl stemi, jacc, LAD, left main, low risk nstemi, primary pci, RCA, stemi, thrombolysis, unstable angina, vulnerable plaque on May 21, 2009 | 2 Comments »
NSTEMI constitutes a very heterogeneous population .The cardiac risk can vary between very low to very high . In contrast , STEMI patients carry a high risk for electro mechanical complication including sudden death .They all need immediate treatment either with thrombolysis or PCI to open up the blood vessel and salvage the [...]
Management of Atrial septal defect : Device closure lagging behind surgical closure !
Posted in cardiac surgery, tagged amplatzer asd device, asd, asd surgery, asdos, device closure, ostium primum, ostium secundum, pfo, starflex on May 11, 2009 | 3 Comments »
Atrial septal defect is one among the commonest congenital heart disease .After years of controversy, there is consensus now , all significant ASDs need to be closed , at whatever age it is detected.
This rule does not apply to small ASDs without chamber right atrial and right ventricular dilatation. These defects and PFOs need not [...]
If ischemia is a powerful trigger for ventricular arrhythmias ,Why cardiac arrhytmias are less common in NSTEMI ?
Posted in Cardiology - Clinical, tagged bundle brancg reentry, cardiac arhhythmias, dc shock, defibrillator, ICD, ischemic vt, lvot vt, madit, madit 2, naspe, nstemi, pace, ventricular fibrillation, ventricular tachycardia, vf, vt, vt in unstable angina on May 10, 2009 | Leave a Comment »
Acute coronary syndrome is the commonest cardiac emergency. STEMI and NSTEMI are the two clinical limbs of ACS. Generally they have distinct clinical, ECG, angiographic features.(Ofcourse, with some degree of overlap) . It is a mystery , both clinical presentations differ so much inspite of the common denominator , namely , an injured plaque with [...]
How good is Troponin T to rule out acute coronary syndrome in the emergency room ?
Posted in Uncategorized, tagged acs, nstemi, stemi, trop t, troponin, troponin i, troponin t, troponin t vs i on May 7, 2009 | Leave a Comment »
How good is Troponin T or I to rule out acute coronary syndrome in the emergency room when a patient presents within two to three hours after the onset of symptoms ?
Very useful
Useful
Rarely useful
Not useful
Not at all useful
The answer is 5 , can be 3 or 4 , never 1 or 2 !
If you are [...]
Biochemical diagnosis of ventricular remodelling
Posted in Cardiology - Clinical, Cardiology -unresolved questions, cardiology -Therapeutics, cardiology- coronary care, tagged stemi, cardiac failure, bnp, VENTRICUALR REMODELLING, REMODELING, post infarc failure, consensus, hope aire study, airex, naturetic pepetide, nt bnp on May 7, 2009 | Leave a Comment »
Ventricular remodeling follows large myocardial infarction .This term denotes to change in size , shape and function of the ventricle due to altered myocyte geometry .It is now believed , this process begins to occur very early following a STEMI.(less than 24hours)
In which MI remodeling is more common ?
Any MI of large size , especially [...]
What is the most important criteria for doing a PCI in CAD ? The secret 6th criteria !
Posted in Uncategorized, tagged pci, acs, stemi, cath lab, stent, primary pci, cabg, gruentzig, ptca, chronic stable angina, nejm, left main disese, tct md, mayo clinic, stenting, scai, jacc, des, taxus, jama, proximal lad, cleaveland clinic, paclitaxel, sirolimus, sirius, flow limiting lesion, acc aha guidelines, coronay revascularisation, triple vesseldisease, courage trial, wisdom trial, syntax score, nstemis, euoropct, cypher stent, ravel on May 4, 2009 | Leave a Comment »
Scientifically , the indication for coronary revascularisation should be based on following
Patient’s symptom ( more specifically angina , dyspnea is less important !)
Prov0kable ischemia ( A significantly positive stress test )
Signifcant LV dysfunction with documented viable myocardium & residual ischemia
A revascularisation eligible coronary anatomy * TVD/Left main/Proximal LAD etc ( *Either 1, 2 or [...]
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