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Condition: Thrombosis

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Total 473 results found since Jan 2013.

An elderly man who dies 12 hours later - could he have been saved?
Sent by Anonymous, written by Pendell Meyers and Steve SmithAn elderly man with good neurologic baseline but history of CABG presented to the ED with acute lightheadedness, shortness of breath, and chest pressure radiating to both arms. He had just recently been admitted for similar symptoms which had been diagnosed as an NSTEMI, and he received a stent to the ostial LCX one week ago. At that time his EF was 30%. He returned to the same hospital where he had just received his LCX stent.Here is his first ECG at triage, with chest pain temporarily resolved:He then had spontaneous return of chest pain while in the ED, wi...
Source: Dr. Smith's ECG Blog - October 22, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

A man in his late 40s with chest pain
 Written by Pendell MeyersA man in his late 40s with no known medical problems was at work when he suddenly experienced midsternal chest pain radiating down both arms. Approximately 1 hour after onset of symptoms he was triaged at the ED, with ongoing chest pain, normal vitals, and this triage ECG:What do you think?Twice, months apart, I sent this ECG to Dr. Smith without any context or other information (I do this many times per day, with many normal or false positive cases mixed in). The first time he responded " acute ischemia but not active occlusion " . The second time he responded " LVH and subendocardial ischem...
Source: Dr. Smith's ECG Blog - September 13, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

Laser atherectomy
Laser atherectomy is a novel technique useful in in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions [1]. An important advantage of excimer laser atherectomy over other atherectomy devices is delivery on a standard 0.014-inch guidewire [2]. The technique can be mastered after a short period of training. Major limitation is the presence of heavy calcification, which requires rotational atherectomy for clearance. But when there is inability to pass a rota wire, laser may be useful in creating an upstream channel to permit rota wire passage. Laser device works by producing mon...
Source: Cardiophile MD - September 11, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

D-Cube syndrome : DES-Dengue-DAPT
Background A 52-year-old diabetic woman who had undergone recent PCI with a DES developed a febrile illness which was diagnosed as Dengue fever. She has been taking DAPT (Dual antiplatelet) meticulously to maintain her stent. Now, her platelet count has dropped from 1.5 and subsequently to 1 lakh. She is asking now, whether to stop DAPT or not? What is the risk of stent occlusion if she stops?  The D³ cube syndrome  Infectious diseases rarely bother a cardiologist (maybe a few IE,  myocarditis, etc). Now, a unique situation is emerging. *Dengue affects 50-100 million people worldwide every year and one billion are ...
Source: Dr.S.Venkatesan MD - September 9, 2021 Category: Cardiology Authors: dr s venkatesan Tags: anti platelet drug antiplatelet drugs in dengue clopidogrel prasugrel ticagrelol in dengue fever dapt in dengue fever therapeutic issues in dengue and cad warfarin heparin in dengue Source Type: blogs

Dark Chocolates and the Heart
Are dark chocolates good for the heart? A study published in Circulation suggests that eating dark chocolate can improve coronary vasomotion and reduce platelet reactivity [1]. Dark chocolates which contain 70% cocoa have lots of flavonoids – potent antioxidants which helps to overcome the oxidative stress. They also decrease the activation of blood platelets responsible for thrombosis. High oxidative stress and limited availability of antioxidants can cause endothelial damage in the arteries, leading to increased chances for a thrombosis. Flavonoid rich dark chocolate has the potential for a beneficial effect on graft ...
Source: Cardiophile MD - September 7, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

A 76 Year Old Female With Recurrent Syncope, Lightheadedness, Palpitations and Negative Stress Test
Written by Lucas Goss MD, peer reviewed by Meyers, Smith, BraceyA 76 year old female with a history of arial fibrillation not on anticoagulation, non-obstructive CAD found on coronary CTA 2 years prior, HTN, HLD, recurrent lightheadedness, and syncope status post loop recorder placement, presented for another episode of feeling lightheaded, diaphoretic, and feeling like she “was going to die.” She was discharged just the day prior for her second hospitalization for similar episodes. She was actually at the pharmacy to pick up her medicines the day after discharge when this episode occurred, and pharmacy staff sat her d...
Source: Dr. Smith's ECG Blog - September 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

A 52 year old female with chest pain
Written by Pendell Meyers, edits by Steve SmithA 52 year old female with history of hypothyroidism and smoking presented to the ED with an episode of chest pain that began suddenly around 1500 while sitting down at work. She states it felt like a central chest pressure that radiated to her jaw. The pain had been persistently present since since 1500 (seen at 1615 in the ED), but had waxed and waned in severity, with the initial onset of pain being the worst. She had dyspnea and diaphoresis when the pain began. Coworkers called EMS who administered aspirin and NTG, which the patient says did not relieve her pain. During ini...
Source: Dr. Smith's ECG Blog - August 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

IMPROVE VTE risk score and modified IMPROVE VTE risk score
IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) score is a weighted VTE (Venous Thromboembolism) risk score designed for medically ill patients [1], which has been externally validated [2]. While formulating the IMPROVE VTE risk score, data from 15,156 medically ill patients were analyzed to find the cumulative incidence of VTE over a 3 month period after admission [1]. Of the 184 patients who developed symptomatic VTE, 67 had lower extremity DVT (deep vein thrombosis) and 76 had pulmonary embolism. Weightage given was 3 points for previous VTE, 2 points for known thrombophilia, 2 points eac...
Source: Cardiophile MD - July 30, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

P2-CHA2DS2-VASc Score
P2-CHA2DS2-VASc score adds additional two points to the CHA2DS2-VASc score for an abnormal P wave axis to predict risk of stroke in atrial fibrillation (AF) [1]. The seminal study was an attempt to identify utility of P wave indices in sinus rhythm to predict the risk of stroke over and above the existing CHA2DS2-VASc score. P wave indices evaluated were prolonged P wave duration, abnormal P wave axis, advanced interatrial block and abnormal P wave terminal force in lead V1. They found that abnormal P wave axis which is an ECG correlate of left atrial abnormality improves the prediction of ischemic stroke. They concluded ...
Source: Cardiophile MD - July 21, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology Image watch : Its not a stent for sure … then what ?
A 75-year-old male post CABG with severe LV dysfunction and ICD and dual-chamber pacer in situ presented with NSTEMI. An angiogram revealed something, and he got this form of treatment. ? What is it? Image and case courtesy Patel R, Ghadiam H, Patel P, et al. (April 05, 2020) Angina Leading to Metal in the Heart: An Interesting Case of Saphenous Vein Graft Coiling. Cureus 12(4): e7546. doi:10.7759/cureus.7546 Features of SVG venous graft aneurysm Graft aneurysm what are the risks? Thrombosis Recurrent ACS Rupture  Management  Vascular plug Multip...
Source: Dr.S.Venkatesan MD - July 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coil occlusion of coronary aneurysm post cabg coronary aneurysm SVG graft aneurysm Source Type: blogs

A 64 year old man with chest tightness
Submitted and written by Kaley El-Arab MDPeer reviewed by Pendell Meyers, Alex Bracey, Stephen Smith A 64-year-old male with past medical history of coronary artery disease with prior MI s/p stent to RCA (2008), hypertension, dyslipidemia, and diabetes presented with acute onset of chest pain.  Around 15:00 while at work he developed left-sided chest tightness that lasted for a few hours, then eventually went away, but returned the same evening around 22:00 when it woke him from sleep. He reportedly tried to “walk it off” which relieved the pain transiently. When the pain returned it was more severe and assoc...
Source: Dr. Smith's ECG Blog - July 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

Cardiology MCQs
Modified Blalock-Taussig shunt is: End to side anastomosis of subclavian artery to a pulmonary artery Side to side anastomosis of main pulmonary artery to aorta Side to side anastomosis of subclavian artery to a pulmonary artery using a conduit Anastomosis of superior vena cava to right pulmonary artery Correct answer: 3. Side to side anastomosis of subclavian artery to a pulmonary artery using a conduit In classic Blalock-Taussig shunt, the subclavian artery is divided and anastomosed to the pulmonary artery as an end to side anastomosis. In modified Blalock – Taussig shunt, a Gore – Tex graft is used to connect th...
Source: Cardiophile MD - July 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Right ventricular infarction
Right ventricular infarction can be associated with inferior wall infarction. It is due to occlusion of the right ventricular branches of the right coronary artery. The actual prevalence of right ventricular infarction may be underestimated because right sided chest leads are not part of routine 12 lead ECG. In a study which included right sided chest leads V3R, V4R, V5R and V6R, ST elevation of 1 mm or more in any of these leads was found to be a reliable sign of right ventricular involvement. It was a study of 67 patients who underwent serial electrocardiograms and 99mtechnetium pyrophosphate scintigraphy and a dynamic ...
Source: Cardiophile MD - June 25, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Percutaneous left ventricular assist devices
This study also documented significantly greater increases in cardiac index and mean arterial blood pressure as well as significantly greater decreases in pulmonary capillary wedge pressure with TandemHeart. Severe adverse events and overall mortality were not significantly different between the two groups. So we need more large scale studies on both types of percutaneous left ventricular assist devices and possibly improvements in their technical aspects to have a greater impact on survival in cardiogenic shock. Ongoing DanShock trial is one such study to look forward to. References Ergle K, Parto P, Krim SR. Percutaneou...
Source: Cardiophile MD - June 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

HOST-EXAM trial
This study is definitely hypothesis generating and calls for a multi national, double blind comparison on a larger scale to get a better conclusion on long term antiplatelet monotherapy after PCI with DES.  AUGUSTUS trial A somewhat similar disadvantage for aspirin was suggested in the AUGUSTUS trial among patients with atrial fibrillation and recent ACS or PCI [2]. Adding apixaban to P2Y12 inhibitor resulted in lower bleeding compared with vitamin K antagonist and a lower rate of death or rehospitalization. Addition of aspirin resulted in greater bleeding without any difference in efficacy. 92.6% of the patients...
Source: Cardiophile MD - June 15, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs