This JAMA paper will stun you : Lesser the cardiac risk factors . . . poorer the outcome !

What is a coronary risk factor ? Right from the days of  Framingham study we have conferred a privileged   place   to  few  cardiac  risk factors. they are Diabetes mellites Hypertension Hyperlipidemia Smoking Obesity They are referred to as conventional risk factors .  What is the convention ?  Do they deserve  the  cult  status [...]

Read Full Post »

How does un-accoustomed exertion trigger an acute coronary syndrome ?

Exertion and  acute coronary syndrome (ACS) has a tricky relationship. On the one  hand, it  would  appear they are not related at all  as only a miniscule of patients   give history of recent severe exertion prior to ACS   , while  few others  tell us  a clear- tale of   unaccustomed  exertion ,  just prior to [...]

Read Full Post »

Early surgery for infective endocarditis (EASE Trial) answers a terrifc debate !

Modern  day cardiology can do wonders. It can revive a sinking  patient in cardiogenic shock with IABP , LV  assist ,   multivessel angioplasty and bring back  life . On  the other  hand  , a young man with an infected mitral valve who is put on  intensive  antibiotic  regimen   , progressively deteriorates  throws an emboli [...]

Read Full Post »

Exclusive guidelines for late presentation of STEMI

Acute myocardial  infarction is the number one cardiac emergency . About a million papers and articles are available in  medical literature about STEMI. Management of STEMI when they present early is addressed by every text book. It is  really surprising to note there is no  simple and  specific guidelines  to manage STEMI when they present [...]

Read Full Post »

What is the difference between physiological and pathological S3 ?

Read Full Post »

Mechanism of genesis of “Third heart sound”

Third heart sound is a unique heart sound  because its   perfect physiology  to hear it  in the young  ,  while the same may denote  serious LV dysfunction in patients with myocardial disease. It is a low pitched  early diastolic sound usually correspond to  the end of rapid filling phase.The mechanism of genesis of this sound has [...]

Read Full Post »

Mechanisms of rheumatic mitral regurgitation

Mitral regurgitation is  one of  the most common lesion of rheumatic heart disease .Mechanism of MR in acute rheumatic fever is different from chronic rheumatic heart disease. Acute Rheumatic fever The following mechanisms contribute to MR of acute rheumatic fever Edema of leaflets (Carey Coombs murmur ) Valvulitis Small verrucous  vegetations (See Image ) Acute [...]

Read Full Post »

Death of a concept called “Pre-discharge” stress test in STEMI !

Sustaining a STEMI  may be a  pathological  end  point  for  coronary  artery disease. But ,  from the  management point of view it is  actually  a starting point for CAD evaluation  .Strategies to prevent further   cardiac  events   must be formulated . How do you manage a asymptomatic  un-complicated  post  STEMI   patient*  at discharge ? Do [...]

Read Full Post »

What is the most important factor that will decide the revascularsation following a STEMI ?

What is  the most important factor that  will decide  the revascularsation following a  STEMI  ? Patient’s  symptoms Residual Ischemia documented by stress  test /Perfusion scan Presence of  significant  LV dysfunction Coronary anatomy and lesion profile Wealth  of the  patient (Insurance  limit  and  other  financial  resources ) Response  2  is   academically correct ,   but    [...]

Read Full Post »

When atrial fibrillation present as bradycardia . . . think about “sinus and AV” nodal disease !

Atrial fibrillation is one of  the common tachycardias encountered in cardiology practice.In this condition even though atria fibrillates  up to 600 times a  minute, only a fraction of that reach the ventricles. Thanks to the AV node.It acts like an electrical sink . Hence in  most  episodes of AF ,  the ventricular rate will  be   manageable and hovers   between [...]

Read Full Post »