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Pharmacological closure and maintaining patency of ductus arteriosus
Prostaglandin E1 is used for maintaining ductal patency in ductus dependent circulations [1]. Both oral [2] and intravenous paracetamol [3] have been used for pharmacological closure of patent ductus arteriosus in newborns. Indomethacin was the earlier drug being used for pharmacological ductal closure, but seldom used now because of its adverse effects. Then came ibuprofen, which is still being used. Paracetamol is the latest addition, with a better side effect profile than ibuprofen. Ductus dependent circulations are classified into ductus dependent pulmonary circulations and ductus dependent systemic circulations. Bo...
Source: Cardiophile MD - December 6, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

65 year old with syncope and a ' normal ' ECG: discharge home?
A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. Vital signs were normal and first ECG was labeled as normal by the computer and confirmed by the treating emergency physician and  cardiology over-read. What do you think? There ’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages with J waves from early repolarization. There ' s inferior down-up ST segments and hyperacute T waves, with reciprocal up-down T wave in aVL. I sent this " normal " ECG without any informa...
Source: Dr. Smith's ECG Blog - December 6, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

Predisposition to statin adverse effects
Some situations likely to predispose to statin adverse effects are impaired renal or hepatic function, history of previous statin intolerance or muscle disorders and unexplained elevation of SGPT. In addition to these, age above 75 years, Asian ancestry and previous hemorrhagic stroke are potential conditions to considered while considering high intensity statin therapy with regard to predisposition for adverse effects. Concomitant usage of drugs likely to affect statin metabolism should also be considered.
Source: Cardiophile MD - December 5, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Potential disadvantages of perioperative heparin bridging
Some of the potential disadvantages of perioperative heparin bridging are risk of thromboembolism due to subtherapeutic dose, more prolonged total hospital stay and cost as well as inconvenience of heparin therapy. In addition to this, there can be excessive bleeding during re-initiation of warfarin with heparin overlap. Hence continuing warfarin through the procedure is becoming standard of care in certain special instances. This is more applicable to procedures with relatively low bleeding risk in those with high risk of thromboembolism. Cataract surgery under topical anesthesia is one such potential situation in which ...
Source: Cardiophile MD - December 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Location of atherosclerotic plaques in relation to a myocardial bridge
Atherosclerotic plaques are usually located 20 – 30 mm proximal to the myocardial bridge. Reversal of systolic flow from the bridge segment has been noted on Doppler tracing. In the coronary segment proximal to the bridge, the retrograde flow collides with the antegrade flow, causing high systolic wall shear stress. This is thought to be the reason for the location of coronary plaques about 20 – 30 mm upstream of the myocardial bridge [1]. Reference 1. Tarantini G et al. Left Anterior Descending Artery Myocardial Bridging: A Clinical Approach. J Am Coll Cardiol. 2016 Dec 27;68(25):2887-2899.
Source: Cardiophile MD - December 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is the best treatment option for prosthetic valve thrombosis presenting with stroke?
In patients having prosthetic valve thrombosis presenting with stroke, surgery is the first option as thrombolysis is contraindicated. Surgical treatment has a combined risk of death or stroke of 9%. For prosthetic valve thrombosis without stroke:  If the thrombus in the prosthetic valve is less than 5 mm in size, only intravenous heparin is recommended. For larger thrombi there are two options: thrombolysis versus surgical treatment. Thrombolysis has an initial success rate of 70 -80%, but there is a 5 -22% risk of embolism, and 5 -12% risk of disabling stroke. Thrombolysis is the preferred treatment ...
Source: Cardiophile MD - December 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

ECG Quiz with Discussion Katz-Wachtel phenomenon
Discussion Katz-Wachtel phenomenon What does this ECG show? This ECG shows Katz-Wachtel phenomenon with large biphasic QRS complexes in mid precordial leads. It is typically seen in infants with large ventricular septal defect and biventricular hypertrophy. In addition, there is sinus tachycardia and right axis deviation which are common in an infant.
Source: Cardiophile MD - December 3, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

ECG Quiz with Discussion
Discussion What does this ECG show? This ECG shows Katz-Wachtel phenomenon with large biphasic QRS complexes in mid precordial leads. It is typically seen in infants with large ventricular septal defect and biventricular hypertrophy. In addition, there is sinus tachycardia and right axis deviation which are common in an infant.
Source: Cardiophile MD - December 3, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Much more than simple white coat syndrome
Ongoing consultations with a new-to-me internist have raised attention to my in-office blood pressure measurements. In preparation for my next appointment, I regularly record my BP, sometimes several times a day. In other office visits, for cancer talks and such, I simply explain I regularly home and grocery store measure my BP, which always seems Read more… Much more than simple white coat syndrome originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - December 2, 2022 Category: General Medicine Authors: Tags: Conditions Cardiology Oncology/Hematology Source Type: blogs

What is secondary AF?
Secondary AF has been defined as self limited atrial fibrillation caused by a reversible etiology. Conditions which cause secondary AF are myocardial infarction, myocarditis, pericarditis, acute pulmonary disease, hyperthyroidism, ethanol intoxication, sepsis and postoperative state. It is well known that postoperative AF can increase the morbidity and ICU/hospital stay after cardiac and non cardiac surgery. Reference Quon MJ, Behlouli H, Pilote L. Anticoagulant Use and Risk of Ischemic Stroke and Bleeding in Patients With Secondary Atrial Fibrillation Associated With Acute Coronary Syndromes, Acute Pulmonary Disease, or...
Source: Cardiophile MD - December 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Ellis classification of coronary perforation during PCI
Symbolic image of coronary perforation Ellis classification is based on angiographic appearance of the perforation [1]. Grade I: Extraluminal crater without extravasation Grade II: Pericardial or myocardial blushing Grade III: Perforations of one or more millimeter diameter with contrast streaming or spilling Reference Ellis SG et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994 Dec;90(6):2725-30.
Source: Cardiophile MD - December 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

In which of the three Eisenmenger syndromes is cardiomegaly unlikely?
In ventricular septal defect with Eisenmenger syndrome, cardiomegaly is unlikely. Though there will be cardiomegaly initially when there is a large left to right shunt, cardiac size regresses when left to right shunt decreases as pulmonary hypertension develops. Pulmonary arteries become prominent. Aorta is not prominent in VSD Eisenmenger. In patent ductus arteriosus with Eisenmenger syndrome, ascending aorta is prominent. Cardiac size comes down in PDA with large left to right shunt when pulmonary hypertension develops. In atrial septal defect, cardiomegaly is mainly due to the enlarged right atrium. Pulmonary arteries ...
Source: Cardiophile MD - December 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

A doctor ’ s grief
Last evening I crumbled in the arms of my patient and wept. This was unknown territory to me, an unexpected role reversal. For three weeks after my Mom’s death, I maintained a stoic distance as patients offered their condolences, as they asked about my mother, and empathized. We doctors have been trained to do this, Read more… A doctor’s grief originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - November 30, 2022 Category: General Medicine Authors: Tags: Physician Cardiology Critical Care Source Type: blogs

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said " Nothing too exciting. "
This article fails to specify whether it was troponin I or T, but I contacted the institution and they used exclusively troponin I during that time period.Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. The impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy. J Electrocardiol [Internet] 2022;Available from: http://dx.doi.org/10.1016/j.jelectrocard.2022.09.009Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%)V Fib Cardiac arrestProlonged QTCNSTEMI (Smith comment: is it NSTEMI or is it Takotsubo?  -- these are entirely different)Moderate sin...
Source: Dr. Smith's ECG Blog - November 30, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

A woman in her 20s with syncope
Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and GrauerA woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope.Her initial vital signs revealed a temp of 97.7F, HR 125, RR 20, BP 115/90, and an oxygen saturation of 95% on room air. Upon arrival, she did not appear in acute distress. She was noted to be tachycardic and her heart sounds were distant on physical exam. She had a normal respiratory effort, and her lungs were clear to...
Source: Dr. Smith's ECG Blog - November 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs