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Procedure: Coronary Artery Bypass Graft
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Total 157 results found since Jan 2013.
Post-CABG wall motion defects : Mechanism and implication.
Wall motion defect , in patients after CABG is fairly common.These defects are difficult to interpret as the mechanisms can be multiple.Though the commonest wall motion defect appears to involve the interventricular septum. it can occur anywhere in antero-lateral zone.
The mechanism attributed is the effect of pericardiotomy , which surgeons as we understand leave it open after grafting .This can cause lack of localised ventricular interdependence and results in a a brisk septal movement (bounce )It is an indirect effect .
Note the, wall motion defects are confined to the exposed areas of the heart during cardi...
Source: Dr.S.Venkatesan MD - December 25, 2015 Category: Cardiology Authors: dr s venkatesan Tags: CABG Cardiology -unresolved questions Echocardiography - LV dysfunction echocardiography following cabg paradoxical wall motion defect in ivs septum cabg post cabg wall motion defect Source Type: blogs
A Fascinating Demonstration of ST/S Ratio in LBBB and Resolving LAD Ischemia
This case was contributed by one of my talented colleagues, Johanna Moore, MD. She is our research director and is doing some great research on cardiac arrest. Check out her research on Head-up CPR!There is more interesting stuff on Head up CPR here. And here.CaseA patient with a history of CABG in 1998, with subsequent ischemic cardiomyopathy, called his clinic to report he had a few minutes of burning chest and epigastric pain, associated with walking, that was now gone. They told him to call 911. Medics arrived and recorded this ECG (pain free) about 15 minutes after the resolution of ...
Source: Dr. Smith's ECG Blog - December 16, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Survival after CABG – Cardiology MCQ
Most important factor affecting survival after CABG (coronary artery bypass grafting):
a) Type of graft used
b) Left ventricular function
c) Number of grafts used
d) Severity of native vessel disease
Correct answer: b) Left ventricular function
Left ventricular function is the most important factor determining survival after CABG. Arterial grafts have a better long term patency and improves symptom free survival.
The post Survival after CABG – Cardiology MCQ appeared first on Cardiophile MD.
Source: Cardiophile MD - November 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Factors predicting stroke after CABG – Cardiology MCQ
Factors predicting stroke after CABG:
a) Presence of intracerebral and extracerebral atherosclerotic disease
b) Demonstration of previous stroke by imaging
c) Atheromatous disease of the aorta
d) All of the above
Correct answer: d) All of the above
Aortic plaques have a high chance of embolization while cannulating the aorta for cardiopulmonary bypass. Avoiding cardiopulmonary bypass with off pump CABG (OPCAB) may have an edge over conventional on pump CABG in this situation. Previous history of stroke or transient ischemic attacks (TIA) within the previous six months is an important risk factor for perioperative stroke. ...
Source: Cardiophile MD - October 15, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Graft failure after CABG – Cardiology MCQ
Which of the following is not a pointer to graft failure after CABG:
a) Electrocardiographic signs of myocardial ischemia
b) Ventricular arrhythmias
c) Two times elevation of CPK
d) New wall motion abnormalities noted on echocardiography
Correct answer: c) Two times elevation of CPK
Five time elevation of CPK is the cut off level for post CABG myocardial infarction. In addition to these, hemodynamic instability could also be a pointer of graft failure.
The post Graft failure after CABG – Cardiology MCQ appeared first on Cardiophile MD.
Source: Cardiophile MD - October 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
ECG Diagnostic of STEMI. But Interventionalist cancels the cath lab.
PrehospitalA male in his 80s was crossing the street, felt weak, and sat down. He denied LOC, chest discomfort or dyspnea. He had no medical history. Here is the prehospital ECG (sorry for the poor resolution):There is profound ST elevation in anterior leads. 3.5 mm at the J-point in lead V3; 5 mm at 60 ms after the J-point. There is convex ST elevation in aVL, with reciprocal concave ST depression in inferior leads. This is diagnostic of STEMI due to proximal LAD occlusion, especially in an 80 year old. Young men could conceivably have this much precordial ST elevation at ba...
Source: Dr. Smith's ECG Blog - September 18, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Value And Limits Of Economic Evaluation In Policy Analysis
Health care resources, no matter how represented, are ultimately finite. Trade-offs occur as spending in one area means that those same resources are unavailable to fund another program. In spite of this, U.S. policymakers remain reluctant to engage in conversations that even hint at “rationing.” This reluctance is evidenced by the fact that the Patient-Centered Outcomes Research Initiative (PCORI) is legislatively forbidden to include cost-effectiveness ratios in its comparative effectiveness evaluations.
Diametrically opposed to the U.S. system, most other countries embrace cost-effectiveness, whereby competing progr...
Source: Health Affairs Blog - September 1, 2015 Category: Health Management Authors: Victoria Phillips Tags: Costs and Spending Drugs and Medical Technology Equity and Disparities Global Health Health Policy Lab Medicaid and CHIP Payment Policy Population Health Quality Comparative Effectiveness cost-effectiveness health economics heart d Source Type: blogs
Praluent, the Next Expensive "Game Changer," Blockbuster," "New Hope," - But Not Yet Shown to Benefit Patients
ConclusionsThe NEJM study was accompanied by an editorial by Stone and Lloyd-Jones(2) which documented that drugs previously shown to lower cholesterol were never proved to do any good for patients, and concluded,it would be premature to endorse these drugs for widespread use before the ongoing randomized trials, appropriately powered for primary end-point analysis and safety assessment, are available. After an FDA advisory committee recommended approval of aliromucab and another PCSK9 inhibitor in June, 2015, John Mandrola entitled a Medscape article,Dear FDA: Resist the Urge on PCSK9 DrugsHis reasons included lack o...
Source: Health Care Renewal - August 5, 2015 Category: Health Management Tags: aliromucab evidence-based medicine health care prices manipulating clinical research PCSK9 inhibitor Praluent Regeneron Sanofi-Aventis Source Type: blogs
Aortocoronary bypass
(ACB) is same as coronary bypass except that connection of a left anterior descending coronary artery to a coronary artery cannot be technically considered as an aortocoronary bypass. Aortocoronary bypass involves using a reversed saphenous vein or a free graft of a radial artery or some other conduit to connect a small opening created in the ascending aorta to the coronary artery distal to the obstruction. In the initial era of coronary artery bypass surgery, aortocoronary bypass was used synonymously as coronary artery bypass grafting because internal mammary artery live grafts were seldom used for coronary bypass. The...
Source: Cardiophile MD - July 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Heart Team
The Heart Team includes clinical or non-invasive cardiologists, interventional cardiologists and cardiac surgeons and is entrusted the process of balanced decision making in case of interventional or surgical therapies for stable, complex coronary artery disease. The concept of a multidisciplinary Heart Team was developed by the SYNTAX Investigators [1] and endorsed by the European (ESC/EACTS) Guidelines on Myocardial Revascularization 2010 [2]. In an interesting study by Long J and colleagues [3] found that on rediscussion of same patient data one year later yielded a different advice in about a quarter of the cases, sugg...
Source: Cardiophile MD - July 1, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiac Surgery Coronary Interventions Source Type: blogs
Porcelain aorta
Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Calcified aorta has an egg shell like appearance. The dense calcification makes the ascending aorta unclampable during procedures requiring cardiopulmonary bypass like coronary artery bypass grafting and valve replacement. The calcification may be detected by chest-ray, CT scan and sometimes by echocardiography (usually trans esophageal). The calcification is also visible during fluroscopy for coronary angiography. When such calcification is detected prior to aortic valve replacement, option of transcatheter aortic valve impla...
Source: Cardiophile MD - June 23, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Antithrombotic for giant coronary aneurysm – Cardiophile MCQ
Most common anti thrombotic regimen for giant coronary aneurysms in Kawasaki disease:
a) Low dose aspirin alone
b) Low dose aspirin + warfarin
c) Low molecular weight heparin
d) Unfractionated heparin
Correct answer: b) Low dose aspirin + warfarin
Giant coronary aneurysms in Kawasaki disease have a high risk of thrombosis. Most commonly used treatment is low dose aspirin along with dose adjusted Warfarin. Aneurysms with proximal and distal stenoses have a higher chance of thrombosis due to higher platelet activation by shear stress at the stenosis and eddy currents within the aneurysm. Presence of a chronic thrombus withi...
Source: Cardiophile MD - June 3, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Influenza vaccination for CABG patients – Cardiology MCQ
Influenza vaccination for CABG patients is a:
a) Class I recommendation
b) Class IIa recommendation
c) Class IIb recommendation
d) Class III recommendation
Correct answer: a) Class I recommendation
As per the American Heart Association (AHA) 2015 guidelines, influenza vaccination should be offered to all coronary artery bypass graft (CABG) patients unless there is a contraindication (Class I recommendation with level of evidence B). In the general population, CentreS for Disease Control and Prevention (CDC) has recommended annual influenza vaccination for all above the age of six months if there is no specific contra indic...
Source: Cardiophile MD - May 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
The affect heuristic and conflicts of interest
Understanding the affect heuristic leads one to expand their understanding of the term “conflict of interest”. My simple explanation of the affect heuristic follows:
If you like something, you overestimate the benefits and underestimate the risk. The contrary holds also. If you dislike something, you underestimate the benefits and overestimate the risks.
This concept helps us understand that we should consider multiple conflicts of interest. Clearly the pharmaceutical and device industries have taken advantage of this concept. They hire very likable representatives. This representatives treat physicians very we...
Source: DB's Medical Rants - May 25, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Bariatric surgery for CABG patients – Cardiology MCQ
Bariatric surgery is recommended for CABG patients if their BMI (body mass index) is more than:
a) Twenty kilograms per square meter body surface area
b) Twenty five kilograms per square meter body surface area
c) Thirty kilograms per square meter body surface area
d) Thirty five kilograms per square meter body surface area
Correct answer: d) Thirty five kilograms per square meter body surface area
As per the American Heart Association (AHA) guidelines 2015, bariatric surgery is recommended for coronary artery bypass grafting (CABG) patients if their BMI is more than thirty five kilograms per square meter (>35 Kg/...
Source: Cardiophile MD - May 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
