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CABG and beta blockers – Cardiology MCQ
Perioperative use of beta blockers in CABG (coronary artery bypass grafting) 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 2015 American Heart Association (AHA) guidelines on secondary prevention after CABG, all patients should be given beta blockers perioperatively to prevent post operative atrial fibrillation, ideally to be started before surgery, if there is no contraindication. It is a Class I recommendation with level of evidence A. Reference Kulik A et al. Secondary prevention after coronary art...
Source: Cardiophile MD - May 21, 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

Cardiology MCQ: AV block after cardiac surgery
Complete AV block requiring permanent pacemaker implantation is more likely after: a) Coronary artery bypass grafting b) Aortic valve replacement c) Mitral valve replacement d) None of the above Correct answer: b) Aortic valve replacement Complete heart block can occur after aortic valve replacement as the conduction system is closely associated with the location of the aortic valve. Pre-existing extension of calcification from aortic valve to the conduction system can cause complete heart block. This can be accentuated by the pressure of the artificial valve on the conduction system. Injury to the conduction system can a...
Source: Cardiophile MD - May 15, 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

My dad’s surgery helped bring me back to the art of medicine
In the midst of seeing a patient, I got a call from another physician, my dad’s new cardiologist. “Looks like he is going to need CABG (open heart surgery) since he has four major blockages.” I was expecting this call, and this result, based on his history of diabetes and at least one month of chest pain. It was still shocking to hear. I walked back into the exam to continue the visit with my own patient with diabetes, probably visibly shaken, so I shared the news with him. Would this medical disease so close to home change the care I provide for my patients? Yet to be determined, but now it was time to c...
Source: Kevin, M.D. - Medical Weblog - February 15, 2015 Category: Journals (General) Authors: Gregory Dodell, MD Tags: Physician Heart Surgery Source Type: blogs

What happened after the PCI?
A middle-aged male with h/o CABG x 3, previous stents, and aortic valve and aortic root replacement presented primarily with headache, but also told the medics that he had chest pain (for 6 hours) because he "knew they would respond faster than if he said headaches."  The chest pain was right sided rib and shoulder pain, worse with inspiration, sharp, and sometimes 7-8/10.  But the headache was much worse.   Chest pain was not relieved by sublingual NTG.He has noticed worsening exertional dyspnea, such that he feels he can only walk about a block before experiencing "chest tightness. Here is his ED ECG ...
Source: Dr. Smith's ECG Blog - October 30, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Cardiology MCQ 341: Type 5 myocardial infarction
According to universal definition of myocardial infarction, Type 5 myocardial infarction is: a) Myocardial infarction secondary to plaque rupture b) Myocardial infarction secondary to hypotension c) Myocardial infarction due to stent thrombosis d) Myocardial infarction associated with coronary artery bypass grafting ["Click here for the answer with explanation", "Correct Answer:"] d) Myocardial infarction associated with coronary artery bypass grafting Myocardial infarction associated with coronary artery bypass grafting (CABG) is termed type 5. Read more on types of myocardial infarction according to universal defin...
Source: Cardiophile MD - October 11, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Learn the essence of Interventional coronary care in 180 seconds flat !
Your clock starts  now !   Chronic stable angina : Most can be effectively managed  by  optimal /intensive medicines and life style Interventions .About 10% will require PCI/CABG. ACS – STEMI:  Primarily  managed  with  rapid and competent  pre-hospital care with prompt thrombolysis in or out of hospital .Patients  with  large STEMI who develop complications (Again about 10 %)   require PCI and few additional  lives can be saved. ACS-NSTEMI : This is  the group that demand  an  important role for PCI . All true high risk UA/NSTEMI patients  should receive urgent coronary  angiogram and critical...
Source: Dr.S.Venkatesan MD - October 3, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions csa ethics in cardiology interventional cardiology management of pci pci ptca in a nutshell priamry pci vs thrombolysis stemi vs nstemi Source Type: blogs

The Hospital Discharge Race: is Sooner Always Better?
They say that if you can remember the 1960s, you weren’t there. I do remember this about 1966, however:  I spent my birthday that year in a hospital bed, where I’d been a patient for a full month recuperating from a ruptured appendix and a nasty case of peritonitis.  Back then during the dawn of civilization, it was common for patients to spend far longer in hospital than we ever would now. For example: For North American maternity patients during the same era, the average length of stay in hospital for uncomplicated vaginal deliveries was about seven days. Today, that stay is more likely to be just 1-2 days(1). F...
Source: Disruptive Women in Health Care - September 10, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs

Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG
This study demonstrates the importance of frequent static ECG’s and the insensitivity of using only 2 static ECG’s to detect reperfusion.  In 58% of patients, ST segments were unstable, rising and falling, before final resolution.Infrequent static ECG’sCaliff RM et al., Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis, 1988.  Methods:  Califf et al. (339) performed angiography on 386 TAMI patients at 60 and 90 minutes post-administration of tissue plasminogen activator (tPA).  They recorded a baseline ECG and another at 90 minutes post-tPA, before ...
Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

The difference between Left Main occlusion and Left Main insufficiency
There are many publications stating that ST elevation in lead aVR, with diffuse ST depression elsewhere, is due to "left main occlusion."  This is even stated in the lastest 2013 ACC/AHA STEMI guidelines, and they reference an article by Jong et al. (Int Ht J 2006; 47(1):13-20.) as evidence.  If you go read that article, "occlusion" was defined as any stenosis greater than 50%.  That is not occlusion, which is 100%.  There are many other articles that confuse Left Main occlusion with Left Main insufficiency, and these are the sources of the mistaken belief that this ECG pattern reflects LM occlusio...
Source: Dr. Smith's ECG Blog - August 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Incredible Case Demonstrating the Value of Frequent Serial ECGs
This case is presented and written by Vince DiGiulio, (EMT-Critical Care and emergency department tech).  As his title shows, he is a tech.  Not a paramedic.  Not a nurse.  Not a doctor.  He is a wizard at reading ECGs and is entirely self-taught.  He was the ECG tech on this case, and his skills mean that he recognized the pathology on the ECG and could stand there and keep recording them.A 75 year old female presents with a chief complaint of “reflux.” Starting about five days ago, a couple of times each day she has experienced a burning sensation behind the lower third of her ...
Source: Dr. Smith's ECG Blog - April 18, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Why I don't Always Follow Guidelines, My Response To Barron Lerner
Barron Lerner thinks he understands doctor's motives.  In his recent article in the Atlantic he laments that physicians act on tradition and emotion over adopting new science.  In defense of his position, he sites the example of how cardiologists use angioplasty and coronary artery bypass to treat coronary disease.  He states:cardiologists have been remarkably slow to abandon the old hypothesis, continuing to perform hundreds of thousands of bypass operations and angioplasties annually not only in the setting of heart attacks (when they are appropriate) but also to try to prevent them.He, of course, makes th...
Source: In My Humble Opinion - April 6, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

Cangrelor – a potential drug for anti platelet bridge therapy
In this study, cangrelor was discontinued 1-6 hours prior to surgery, while aspirin was continued through out the perioperative period. Bridging with cangrelor did not increase major bleeds prior to surgery, though minor bleeds, mostly ecchymosis at venipuncture site, was higher. P2Y12 assay documented sufficient platelet inhibition corresponding to levels required for anti thrombotic effect [Angiolillo DJ et al; BRIDGE Investigators. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307:265–274]. Cangrelor is awaiting approval and more large ...
Source: Cardiophile MD - January 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Cardiovascular surgeries with high risk of bleeding
: Re-do surgeries Surgeries in the setting of infective endocarditis Coronary artery bypass grafting (CABG) after failed percutaneous coronary intervention (PCI) – bail out procedures Aortic dissection Open surgeries for thoracic and abdominal aorta
Source: Cardiophile MD - January 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Hospital Quality Helps Explain Some Of The Racial Disparities In Outcomes After CABG
It has long been known that racial disparities exist in health care. A large body of research has found that nonwhite patients have worse outcomes than whites. But it has been difficult to understand the underlying reasons for these disparities.  Now a new study offers evidence that, at least in the case of bypass surgery, a significant but by no means complete portion of this disparity is due to decreased access among nonwhites to high quality hospitals. In a paper published in JAMA Surgery, Govind Rangrass and colleagues analyzed Medicare data from 173,925 CABG patients. 8.6% of the More…
Source: CardioBrief - January 8, 2014 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics Prevention, Epidemiology & Outcomes bypass surgery CABG Medicare racial disparities Source Type: blogs

Stents Lose In Comparisons With Surgery And Medical Therapy
Despite the enormous increase in the use of stents in recent decades, there is little or no good evidence comparing their use to the alternatives of CABG surgery or optimal medical therapy in patients also eligible for these strategies. Now two new meta-analyses published in JAMA Internal Medicine provide new evidence that the alternatives to PCI remain attractive and that some of the growth in PCI may have been unwarranted. … Click here to read the full post on Forbes.  
Source: CardioBrief - December 3, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery Policy & Ethics Boston Scientific CABG Coronary artery bypass surgery coronary artery disease European Society of Cardiology Medtronic myocardial infarction Percutaneous coronary intervention stents Source Type: blogs

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