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Fontaine classification for peripheral arterial disease
In Fontaine classification [1,2], Stage I is asymptomatic with incomplete vascular obstruction. Stage II is with mild claudication which is divided into A with claudication distance more than 200 m and B with claudication distance less than 200 m. Stage III is with rest pain and stage IV with necrosis or gangrene in the limb.
Rutherford classification classified peripheral arterial disease into acute and chronic limb ischemia [3]. Each is further subdivided into grades and categories based on symptoms, clinical findings, Doppler, ankle brachial index (ABI) and pulse volume recordings.
References
Fontaine R, Kim M, Kieny ...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the most common cause of acquired heart disease in children in developed countries?
Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. In developing countries it will be rheumatic heart disease.
Timely treatment of Kawasaki disease with intravenous immunoglobulin can reduce the incidence of coronary aneurysms from 25% to around 4%. Children with coronary aneurysms due to Kawasaki disease needs lifelong cardiology follow up. The prognosis depends on the initial and current level of coronary involvement. Some children may develop coronary obstruction and thrombosis leading to myocardial infarction. Revascularization procedures may be needed in some of th...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Non-vitamin K antagonist oral anticoagulants (NOACs) and valvular heart disease with AF
Subgroup analysis of certain clinical trials support the use of rivaroxaban, apixaban, dabigatran and edoxaban in patients with aortic stenosis, aortic regurgitation or mitral regurgitation having atrial fibrillation. NOACs can also be used in aortic bioprosthesis with atrial fibrillation if the valve has been implanted more than 3 months back.
NOACs are better avoided in those with moderate or severe mitral stenosis and atrial fibrillation in view of high thromboembolic risk. NOACs should not be used in those with mechanical prosthetic valve with or without atrial fibrillation. Those patients still require vitamin K anta...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the statin adverse effects with confirmed causality?
Statin adverse effects with confirmed causality, though rare are:
a) Myalgia/myopathy
b) Temporary elevation of alanine aminotransferase
c) New onset diabetes mellitus
Reference
Banach M et al; International Lipid Expert Panel (ILEP). The Role of Nutraceuticals in Statin Intolerant Patients. J Am Coll Cardiol. 2018 Jul 3;72(1):96-118. doi: 10.1016/j.jacc.2018.04.040. PMID: 29957236.
Source: Cardiophile MD - November 16, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
In what conditions are descending aortic flow reversal seen on Doppler echo?
Descending aortic flow reversal can be noted in aortic regurgitation, rupture of sinus of Valsalva into right ventricle and patent ductus arteriosus. It may be noted that transient descending thoracic aortic flow reversal may be detectable by Doppler echo without any of these conditions.
When the aortic wall is stiff as in hypertensives with atherosclerosis, transient flow reversal is thought to be one mechanism for cerebral embolism from aortic plaques beyond the origin of cerebral vessels.
In severe aortic regurgitation it is a pan diastolic flow reversal with end diastolic velocity more than 20 cm/s. It is taken as an ...
Source: Cardiophile MD - November 16, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the Effect of venoarterial ECMO on LV afterload?
Venoarterial extracorporeal membrane oxygenation or VA-ECMO increases left ventricular afterload. VA-ECMO is used as a mechanical circulatory support for cardiogenic shock. But it results in increased left ventricular afterload which can have deleterious effects like myocardial ischemia, delayed left ventricular recovery, ventricular arrhythmias and pulmonary edema.
Several interventions have been used to unload the left ventricle during VA-ECMO. The most commonly used strategy is intra-aortic balloon pump or IABP. Other less frequently used methods are percutaneous left ventricular assist device and pulmonary vein or tra...
Source: Cardiophile MD - November 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Which chemotherapeutic agent is well known to cause coronary vasospasm?
5-fluorouracil is well known to cause coronary vasospasm. 5-fluorouracil and its orally active prodrug capecitabine are fluoropyrimidines, belonging to the class of antimetabolites used for treatment of malignancies of breast, head and neck tumours and gastrointestinal tumours.
Mechanisms for coronary vasospasm
Endothelial cell damage with cytolysis and denudation
Increased endothelin-1 bioactivity leading to vasoconstriction
When high dose infusions are given, coronary vasospasm with angina, arrhythmia or even sudden death can occur in up to 5% of patients. Vascular toxicity occurs generally within 72 hours of the...
Source: Cardiophile MD - November 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
When do you consider workup for hyperaldosteronism?
Important situation in which hyperaldosteronism is suspected is when there is hypertension with hypokalemia. Hypertension with spontaneous as well as diuretic induced hypokalemia may be an indication of hyperaldosteronism. Another reason for workup is refractory hypertension in spite of three antihypertensive medications. Hypertensive patient having hypokalemia while on angiotensin converting enzyme inhibitors or angiotensin receptor blockers should also alert us.
Yet another group is hypertensives with adrenal masses detected on imaging studies. First degree relatives of patients with primary hyperaldosteronism need work...
Source: Cardiophile MD - November 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Apple Heart Study – Clinical Trial Review
Apple Heart Study – Clinical Trial Review
The Apple Heart Study was designed as a large-scale, app-based study to identify cardiac arrhythmias using a smartwatch [1]. Pulse rate can be measured using smartwatch and fitness band wearable consumer electronic devices by photoplethysmography. Pulse irregularity from these data can potentially identify atrial fibrillation.
Participants without self reported atrial fibrillation used a smartwatch (Apple iPhone) app to consent to monitoring. If possible atrial fibrillation was detected by the smartwatch algorithm, a telemedicine visit was initiated and an ECG patch was maile...
Source: Cardiophile MD - November 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What Duplicate Patient Notes Reveal About Health Care and Its Records
Bloat in patient notes has been alarming doctors for some time. The American Medical Informatics Association began a project to reduce patient documentation to 25% of its current volume by 2025. This task won’t be solved by any single organizer or sector; the AMIA calls on providers and health systems, Health IT vendors, and policy and advocacy groups to join the effort.
A recent study in a JAMA publication, “Prevalence and Sources of Duplicate Information in the Electronic Medical Record,” helps drive discussion of bloat forward by focusing on one manifestation: the duplication of text from one patient n...
Source: EMR and HIPAA - November 11, 2022 Category: Information Technology Authors: Andy Oram Tags: AI/Machine Learning Ambulatory Clinical EMR-EHR Health IT Company Healthcare IT AdvancedMD Amazon Comprehend Medical AMIA billing CipherHealth Cloudticity Cumberland Heights Foundation Donna Pritchard Doug McGill EHR Document Source Type: blogs
Monitoring Congestive Heart Failure Through Speech: Interview with Tamir Tal, CEO of Cordio Medical
Cordio Medical, a medtech company based in Israel, has developed HearO, an app that can assist in monitoring congestive heart failure. The technology is based on the phenomenon whereby congestive heart failure patients demonstrate changes in their vo...
Source: Medgadget - November 11, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Diagnostics Exclusive CHF Congestive Heart Failure Source Type: blogs
MobilTEK Launches First International Telehealth Program
The following is a guest article by Sara Hendren, Global Telehealth Lead at MobilTeK by Care on Location.
MobilTEK, launched its first international telehealth program in the department of Chuquisaca Bolivia in March of 2022. Through a collaborative partnership with Alliance Bolivia, PROCOSI, and SEDES Chuquisaca, two MobilTEK telehealth exam kits were placed in the communities of Zudanez and El Villar through a pilot program that will study the acceptability, useability, and adaptability of telehealth technology in relation to the current flow of patient care and to address the distance gap between specialist and patien...
Source: EMR and HIPAA - November 11, 2022 Category: Information Technology Authors: Guest Author Tags: Ambulatory Health IT Company Healthcare IT Telemedicine and Remote Monitoring Alliance Bolivia Care on Location Chagas Disease Chuquisaca Bolivia El Villar MobilTEK MobilTEK Telehealth Kit PROCOSI Rural Communities Sara Hendren Source Type: blogs
Device Measures Hemoglobin More Accurately in Dark Skin
Researchers at the University of Texas at Arlington, in collaboration with Shani Biotechnologies, a local firm, have created a point-of-care device that can accurately measure hemoglobin levels and perform pulse oximetry in individuals with dark skin...
Source: Medgadget - November 11, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Military Medicine Pediatrics Surgery utarlington Source Type: blogs
Patient empowerment movement, definitely has a good intention , but …
The definition & intended purpose of patient empowerment
WHO defines empowerment as “a process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.1
Four components have been reported as being fundamental to the process of patient empowerment: 1) understanding by the patient of his/her role; 2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider; 3) patient skills; and 4) the presence of a facilitating environm...
Source: Dr.S.Venkatesan MD - November 11, 2022 Category: Cardiology Authors: dr s venkatesan Tags: cardiology-ethics Medical education ethics in medicine patient empowerment Source Type: blogs
An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex
Written by Pendell MeyersFamily of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. She was alert and oriented and hypotensive with initial BP 70/50. A 12 lead ECG was obtained by EMS and is shown below:What do you think?There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in mo...
Source: Dr. Smith's ECG Blog - November 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
