No one can deny , there is a huge revascularisation dilemma between CABG and PCI in patients with CAD. This is especially prevalent in multivessel disease in chronic coronary syndromes.
In acute STEMI , CABG is never considered as a primary revascularisation procedure.There should be strong reason for this ! Few studies , suggested a role for CABG [...]
Archive for June, 2009
Primary PCI is great for STEMI but “Primary CABG ” is not why ?
Posted in Uncategorized on June 28, 2009 | Leave a Comment »
How oral amiodarone differs form IV amiodarone ?
Posted in Uncategorized on June 28, 2009 | Leave a Comment »
Amiodarone has brought a major change in the medical management of ventricular arrhythmias over the last few decades. It is a powerful antiarrhytmic drug , with all class 1 -4 action (of vaugan williams classification.) It has sodium , pottasium, calcium and beta blocking properties. Hence there is no surprise, amiodarone is aptly called a broadspectrum anti [...]
Should all patients with positive excercise stress test (EST) undergo coronary angiogram ?
Posted in Cardiology - Clinical, Uncategorized, tagged csa, stable angina on June 26, 2009 | Leave a Comment »
Exercise stress test ( Also called treadmill test ) is an important investigation not only in patients with suspected CAD but also in established CAD . In the former group , it helps us to exclude CAD in patients with chest pain and in the later group , it helps us to assess functional capacity [...]
Why we are not classifying NSTEMI ?
Posted in cardiology -Therapeutics, tagged acs, nstemi, unstable angina on June 22, 2009 | Leave a Comment »
NSTEMI constitutes an important sub group of ACS. In fact it forms the major group. Real world data would indicate it UA/NSTEMI could form up to 75% of all admissions for ACS in any cardiac emergency units. Risk stratification of NSTEMI is important and is available. It is one primarily with clinical features , [...]
Circadian variation in thrombolysis efficacy : Streptokinase works best in the evenings !
Posted in Uncategorized, tagged stemi, nstemi, thrombolysis, circadian variation on June 22, 2009 | Leave a Comment »
In thrombolysis of STEMI , there is a less published , but interesting observation . It is often noted , variation in the efficacy of streptokinase according to the time it was administered.It was most effective in the evenings and least effective in the early morning hours. The mechanism is thought to be due [...]
“Benefit of doubt” and the “risk of doubt” in cardiac care”
Posted in Cardiology - Clinical, tagged pci, acs, stemi, nstemi, thrombolysis, ethics, primary pci, ebm, nejm, evidence based medicine, des, jama, annals of internal medicine, coroanry care, clinical dicision making on June 19, 2009 | Leave a Comment »
When a doctor is confronted by serious doubt , what will be the outcome for the patient ?
Can doubting be beneficial for a patient ? . It seems so , according to EBM which stresses about statistical outcome at every turn of events in a patient who is critically ill .
Is something , always [...]
Therapeutic issues in STEMI :Persistent sinus tachycardia following thrombolysis
Posted in Uncategorized, tagged stemi, nstemi on June 16, 2009 | Leave a Comment »
Sinus tachycardia in the early hours of STEMI is a very common arrhythmia. This seemingly simple problem can be really worrisome to many cardiologists and give sleepless nights(While the patient may sleep comfortably !)
The importance of sinus tachycardia in STEMI primarily lies in answering the following question
A. Is it compensatory sinus tachycardia ? , [...]
Is there a low risk STEMI where primary PCI is contraindicated ?
Posted in cardiac drugs, tagged acs, nstemi, primary pci, stemi, syntax on June 14, 2009 | Leave a Comment »
Primary PCI has proven to be the best option for management of STEMI . But it need to be done very early by a an experienced team in a good facility . (Note , it is not the individual expertise that matters ! Ronalodo alone can never guarantee a match win ! )
Any treatment [...]
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