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Coronary subclavian steal syndrome
Coronary subclavian steal syndrome is the diversion of blood from the coronary circulation to the exercising left upper limb after a coronary artery bypass graft (CABG) using left internal mammary artery [1]. This occurs when there is a high grade stenosis or occlusion of left subclavian artery proximal to the origin of the left internal mammary artery (LIMA). Though it is a rare phenomenon, it is a serious threat to the success of CABG. Cardiovascular manifestation of coronary subclavian steal syndrome could be angina, myocardial infarction, malignant arrhythmias or heart failure [1]. Cerebral symptoms can occur due to ...
Source: Cardiophile MD - April 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Getting It Right Despite the Wrong Paradigm
Written by Alex Bracey, edits by Meyers and SmithA 50 something year old male presented to the ED as a transfer from an outside hospital with chest pain. As EMS gave report I looked through the transfer packet for the initial ECG:Sinus bradycardia with loss of R-wave progression and hyperacute T-waves in V2-V5, slight STE in aVL and I without meeting STEMI criteria. There is a down-up T-wave in lead III, which is a very specific reciprocal finding in high lateral OMI. Very highly suspicious of OMI. Applying the 4-variable formula for detection of subtle anterior OMI would yield: STE60V3 = 2.5, QTc = 360, RV4 = 3, QRSV2 = 5...
Source: Dr. Smith's ECG Blog - April 12, 2021 Category: Cardiology Authors: Bracey Source Type: blogs

Coronary collateral circulation : Why many scientific cardiologists Ignore it ?
A consult with a 62-year-old patient in my office  Hi, welcome?  What is your problem? Nothing doctor. I am good.  What brings you here then? I used to have angina before. Now, I am fine doctor but confused after undergoing this angiogram. I need an opinion. How is your exercise capacity? I do walk, work, and able to do almost all regular activities. Why did you do this angiogram then?  Had to undergo this after a doubtful stress test, Now, I am told by at least 2 eminent cardiologists, that I am having just one functional coronary artery, and it is dangerous for the all-important LAD to live at the merc...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized chronic total occlusion collateral circualtion in cto coronary collateral circulation interventions in cto Source Type: blogs

ST Depression Maximal in V1-V4 and Angio shows 3 Vessel Disease. Is it posterior? Which is the culprit?
A 70-something woman had acute chest pain.The ECG was texted to me with the words: " Acute chest pain. Could this be posterior MI? What do you make of the ST depression in V4-V6? "What do you think?My response: " The ST depression is maximal in V1-V4.  This is most consistent with a posterior MI.  If it sounds clinically like acute MI then this is good for activating the cath lab. "Her response: " Yeah, I did activate.  But the cardiology fellow told me he was sure it would not be a posterior MI because of diffuse ST depression.  He suggested that we should have consulted cardiology rather than activati...
Source: Dr. Smith's ECG Blog - December 23, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

LA myxoma surgery : Preventing recurrence should be an important goal.
Cardiac myxoma is the most common primary tumor of the heart that presents as mitral inflow obstruction/ regurgitation often with a systemic presentation. It can be either familial, syndromic, or sporadic. Excellent imaging is possible and diagnosis has become straightforward. Surgery is the specific treatment, What information do the Surgeons need?  Size, attachment to surrounding structures is the key. The myxoma origins most often in IAS and defining its attachment is crucial. Mitral leaflet distortion, Injury ( and even attachment) is possible. It is helpful for the surgeons if we let them know the mechanism of mit...
Source: Dr.S.Venkatesan MD - December 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiac myxoma IAS patch closure for myxoma LA myxoma surgery mesenchymal cell tumor myxoma myxoma benign or malignant Source Type: blogs

Cardiologists need to keep an open mind and be capable of listening to, and learning from, the Emergency Physician
Conclusion: This represents the largest study of patients with VPR and angiographically-proven ACO. The MSC were highly sensitive and specific for the diagnosis of ACO in patients presenting to the ED with VPR and symptoms of acute coronary syndrome.===================================MY Comment by KEN GRAUER, MD (10/4/2020):===================================Today ’s case provides a superb example of how acute OMI can sometimes be definitively recognized even in the presence ofpacing. Unfortunately, this was not recognized by the cardiology team despite&nbs...
Source: Dr. Smith's ECG Blog - October 4, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

Don ’ t Confuse the Art and Science of Medicine: PCI vs CABG for Left Main Disease
It is often said that medicine is both an art and a science. In an imperfect world this is both inevitable and desirable. But it is extremely important that the two should not be confused with each other. In particular, because the “science” side of the equation has achieved overwhelming prestige and authority, it is...Click here to continue reading...
Source: CardioBrief - August 20, 2020 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics CABG guidelines left main disease LMCA PCI Source Type: blogs

What is a useful next step in the evaluation of this patient with Chest pain and this ECG?
Written by Pendell Meyers, submitted by Daryl Williams, edits by Steve SmithA man in his sixties with prior CAD and CABG experienced chest pain and pressure off and on for three days. He saw his primary doctor during this time who had suspected GI related symptoms and increased his PPI medication. On the third day it became more intense and had associated radiation to his neck and left arm, and this reminded the patient of his prior MI symptoms, so he presented to the Emergency Department. It is unclear how long he had constant symptoms during those three days.Here is his triage ECG (no prior was available in our system):W...
Source: Dr. Smith's ECG Blog - July 18, 2020 Category: Cardiology Authors: Pendell Source Type: blogs

Brown vs white adipose tissue roles of pericardial fat
This study was conducted using serum and adipose tissue samples collected from pericoronary depots in patients undergoing coronary artery bypass grafting and patients without coronary artery disease undergoing aortic valve replacement [3]. Adipokine synthesis pattern of epicardial also changes in obesity and dyslipidemia. Adiponectin synthesis comes down and proinflammatory adipokines like leptin, tumour necrosis factor alpha, interleukin 1 beta, interleukin 6 and resistin gets synthesised. These are proinflammatory, causing macrophage infiltration, destruction of microvasculature and increase in fibrosis [1]. In one study...
Source: Cardiophile MD - April 28, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?
This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates. A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms ...
Source: Harvard Health Blog - April 27, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Surgery Source Type: blogs

Radiation induced coronary artery disease – RICAD
Radiation induced coronary artery disease – RICAD Radiation induced coronary artery disease (RICAD) is an important long term sequelae of radiotherapy to the chest region. The most common conditions associated with RICAD are breast cancer and Hodgkin’s lymphoma. The risk is higher in Hodgkin’s lymphoma because they receive a higher dose of radiotherapy [1]. It may be noted that radiation is used in the treatment of about 50% of cancers [2]. Hence the importance of RICAD. Radiation causes vascular endothelial injury. It initiates and accelerates atherosclerosis. Proinflammatory cytokines were increased in ...
Source: Cardiophile MD - April 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Onco Cardiology Source Type: blogs

A man in his 60s with chest pain. The ST segments and T waves are ALWAYS interpreted in the context of their QRS.
Written by Pendell MeyersA man in his 60s with history of CAD, CABG, HTN, DM, and smoking presented with chest pain,and shortness of breath over the past 1 hour, and a mild cough over the past few days, of course asking for COVID testing.Here is his ECG on presentation (shown to me with no information):What do you think?Raw Findings: - RBBB (some will also say LPFB) - Negative T-waves in V1-V3 - STD in V1-V6, I, aVL - STE in aVR - V2 has strange QRS morphology that does not seem to fit in the progression between V1 and V3, possibly lead misplacementInterpretation:In the context of RBBB, it is norma...
Source: Dr. Smith's ECG Blog - April 12, 2020 Category: Cardiology Authors: Pendell Source Type: blogs

Recognizing and treating depression may help improve heart health
Depression affects about 20% of Americans in their lifetime, and is one of the leading causes of disability. The rates of depression are even higher in those with cardiovascular disease (CVD). Depression affects 38% of patients undergoing coronary artery bypass graft surgery, and the risk of depression is three times as high in patients who have experienced a heart attack compared with the general population. Depression also makes it much more likely that CVD patients will be readmitted to the hospital and report heart-related symptoms. Yet much of the time, symptoms of depression in those with CVD go unrecognized. And as ...
Source: Harvard Health Blog - April 2, 2020 Category: Consumer Health News Authors: Alyson Kelley-Hedgepeth, MD Tags: Anxiety and Depression Health Heart Health Source Type: blogs

A man in his 30s with chest pain
Written by Pendell Meyers, case submitted by Tom FieroA man in his 30s walked into the ED complaining of chest pain. His triage ECG was done at 11:30 (no prior was available):What do you think?Sinus tachycardiaNormal QRS complex pattern, with borderline low voltageVery slight STE in leads V2-V5Proportionally large and fat T-waves in V4-5 with straightening of the ST segmentsT-waves also concerning in II, III, aVF, with inappropriately negative T-waves in aVLUsing the LAD OMI vs. BER formula:3 Variable: 27.34 (positive for OMI, using STE60V3=1.5mm, QTc=444, RWV4=2.0mm)4 Variable: 23.01 (positive for OMI, using QRS amplitude...
Source: Dr. Smith's ECG Blog - March 28, 2020 Category: Cardiology Authors: Pendell Source Type: blogs

A young peripartum woman with Chest Pain
This is written by Brooks Walsh.https://twitter.com/BrooksWalshA 30 year-old woman was brought to the ED with chest pain.It had started just after nursing her newborn, about an hour prior, and she described it as a severe non-pleuritic “pressure” radiating to the back.She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying " I ' m just an anxious person. "A CXR and a CTA for PE were normal.The ECGsAn initial ECG was obtained as the pain was rapidly resolving:Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and&nbs...
Source: Dr. Smith's ECG Blog - October 23, 2019 Category: Cardiology Authors: Brooks Walsh Source Type: blogs

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