Latest Trials on CAD from 2020 ESC Congress
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LoDoCo2 Trial: low-dose colchicine reduced the risk of major cardiovascular events in patients with CAD ATPCI: Trimetazidine in Angina Patients With Recent Successful Percutaneous Coronary Intervention RAPID CTCA :Early Coronary CT Angiography in Patients With Suspected or Provisionally Diagnosed Acute Coronary Syndrome OCT and MRI Find an MI Cause in 85% of Women With MINOCA: HARP
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This document describes the case of a 58-year-old man who presented with chest pain and was diagnosed with an inferoposterior myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. Initial treatment included medications, percutaneous coronary intervention to open the blocked artery, and supportive care. Despite intensive medical management, the patient's condition deteriorated with the development of ventricular septal defect. Surgical repair was considered but the patient expired from cardiogenic shock before a procedure could be performed. The key learning points are the importance of early recognition of pre-shock states, the high mortality of ventricular septal rupture, and the need for a multidisciplinary approach and care at an experienced center to manage such complex cases.
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This document describes the case of a 58-year-old man who presented with chest pain and was diagnosed with an inferoposterior myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. Initial treatment included medications, percutaneous coronary intervention to open the blocked artery, and supportive care. Despite intensive medical management, the patient's condition deteriorated with the development of ventricular septal defect. Surgical repair was considered but the patient expired from cardiogenic shock before a procedure could be performed. The key learning points are the importance of early recognition of pre-shock states, the high mortality of ventricular septal rupture, and the need for a multidisciplinary approach and care at an experienced center to manage such complex cases.
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Stop That Clot
The document discusses the management of massive pulmonary embolism (PE), which is defined as PE with systolic blood pressure ≤90 mmHg or a pressure drop of >40 mmHg for 15 minutes. It describes evaluating patients for right ventricular dysfunction using CT, echocardiogram, or biomarkers. For confirmed massive PE, initial treatment involves heparin, supportive care, and consideration of thrombolysis which reduces mortality compared to heparin alone but risks bleeding. Catheter-directed thrombolysis or surgical embolectomy are alternatives if thrombolysis is contraindicated or fails.
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The ATLAS-ACS 2 trial found that low-dose rivaroxaban (2.5mg twice daily) added to dual antiplatelet therapy after acute coronary syndrome reduced the composite of death, heart attack, and stroke compared to placebo, but increased bleeding risk.
The COMPASS trial showed that in stable coronary or peripheral artery disease patients, low-dose rivaroxaban (2.5mg twice daily) added to aspirin reduced the composite of death, heart attack, and stroke compared to aspirin alone, again with increased bleeding.
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1. The document discusses the pharmaco-invasive approach for patients presenting with ST elevation myocardial infarction (STEMI) in India. This approach involves initially administering early fibrinolytic therapy followed by angiography and percutaneous coronary intervention (PCI) within 3-24 hours, regardless of the success of fibrinolysis.
2. It highlights challenges with the current STEMI system of care in India such as lack of awareness, limited transfer facilities to PCI-capable hospitals, and delays in initiating reperfusion therapy. The pharmaco-invasive approach aims to shorten time to reperfusion of the infarct-related artery.
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The document discusses strategies for early treatment of acute myocardial infarction. It provides evidence that pre-hospital thrombolytic therapy can significantly reduce mortality rates compared to in-hospital thrombolytic therapy by reducing treatment delays. Studies show administering thrombolysis within 30-60 minutes of symptoms onset can save 11-60 lives per 1000 patients. Combined strategies using both pre-hospital thrombolysis and immediate angioplasty have demonstrated high rates of coronary reperfusion and good long-term outcomes.
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The document discusses different strategies for reperfusion in ST-elevation myocardial infarction (STEMI) patients, including primary percutaneous coronary intervention (PPCI), fibrinolysis, and PCI following fibrinolysis. It summarizes the TRANSFER-AMI trial which compared a "pharmacoinvasive" strategy of early PCI within 6 hours of fibrinolysis to standard treatment of PCI only for failed reperfusion in high-risk STEMI patients initially treated with fibrinolysis. The trial found the pharmacoinvasive strategy reduced the primary composite endpoint of death, reinfarction, or ischemia at 30 days with no increase in bleeding risks compared to standard treatment.
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1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
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El Dr. Alfonso Valle Muñoz comenta los resultados del estudio con dapagliflozina en insuficiencia cardiaca, presentado en ESC Congress 2019.
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Rivaroxaban has been studied as an addition to antiplatelet therapy in patients with coronary artery disease in several large trials.
The ATLAS-ACS 2 trial found that low-dose rivaroxaban (2.5mg twice daily) added to dual antiplatelet therapy after acute coronary syndrome reduced the composite of death, heart attack, and stroke compared to placebo, but increased bleeding risk.
The COMPASS trial showed that in stable coronary or peripheral artery disease patients, low-dose rivaroxaban (2.5mg twice daily) added to aspirin reduced the composite of death, heart attack, and stroke compared to aspirin alone, again with increased bleeding.
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The document discusses the future of cardiac resynchronization therapy (CRT). It notes that while CRT has been successful, current technology still has unmet needs like suboptimal response rates, relatively high complication rates, and long unpredictable procedure times. The document outlines Medtronic's work to address these issues through innovations like AdaptivCRT technology, which aims to produce more synchronized left ventricular pacing for improved outcomes. It also discusses the development of leadless pacing technologies and percutaneous approaches that could simplify CRT and reduce risks in the future. The overall message is that CRT technology will continue to advance towards making the procedure quicker, safer, simpler and more predictable with higher response rates and lower complication risks.
STEMI – My Approach 2010
- Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed at an experienced center within 120 minutes of first medical contact. Fibrinolysis is an alternative if PCI cannot be performed within this time window.
- Clopidogrel in combination with aspirin results in significant improvements in outcomes for STEMI patients over aspirin alone based on the CLARITY-TIMI 28 and COMMIT trials.
- Enoxaparin is superior to unfractionated heparin as an anticoagulant to support reperfusion therapy for STEMI based on the ExTRACT-TIMI 25 trial.
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Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
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This document discusses catecholaminergic polymorphic ventricular tachycardia (CPVT), a condition characterized by adrenergically mediated polymorphic ventricular arrhythmias without structural heart disease. It has a prevalence of 1 in 10,000 and mortality of up to 50% before age 20 if untreated. The gold standard for diagnosis is exercise stress testing showing exercise-induced bidirectional or polymorphic ventricular tachycardia. Treatment involves lifestyle changes, beta-blockers, flecainide, and an ICD for those with cardiac arrest or recurrent arrhythmias despite medical therapy. Genetic testing identifies mutations in RYR2 or CASQ2 genes in the majority of cases.
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The document discusses insights from the ISCHEMIA and ISCHEMIA-CKD trials regarding clinical and quality of life outcomes across different levels of baseline kidney function. It evaluated how treatment strategy impacts outcomes depending on estimated glomerular filtration rate (eGFR). The trials examined time to death or heart attack as the primary endpoint, as well as secondary endpoints of other cardiac events and quality of life. The conclusions were that cardiovascular events increased exponentially with lower kidney function, procedural complications and bleeding also increased, and while an invasive strategy improved angina-related quality of life, the effect was attenuated in those with fewer symptoms or eGFR below 30-45.
Pharmacoinvasive approach for stemi
1. The document discusses the pharmaco-invasive approach for patients presenting with ST elevation myocardial infarction (STEMI) in India. This approach involves initially administering early fibrinolytic therapy followed by angiography and percutaneous coronary intervention (PCI) within 3-24 hours, regardless of the success of fibrinolysis.
2. It highlights challenges with the current STEMI system of care in India such as lack of awareness, limited transfer facilities to PCI-capable hospitals, and delays in initiating reperfusion therapy. The pharmaco-invasive approach aims to shorten time to reperfusion of the infarct-related artery.
3. Guidelines for the pharmaco-invasive approach in the Indian setting are provided, including recommendations on agent choice
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This document summarizes new developments in pharmacology for interventional cardiology. It discusses the treatment of antithrombotic therapy in patients with atrial fibrillation who have had an acute coronary syndrome or percutaneous coronary intervention. Specifically, it reviews results from the AUGUSTUS trial, which compared apixaban to vitamin K antagonists and aspirin to placebo in over 4,600 such patients. The trial found that apixaban resulted in significantly less bleeding and fewer hospitalizations compared to vitamin K antagonists, without significant differences in ischemic events. Aspirin resulted in higher bleeding risk. Given total data, the document recommends using direct oral anticoagulants over vitamin K antagonists for these patients.Resumen ejecutivo guías tromboprofilaxis, chest, 2012
The executive summary provides a concise overview of the key changes and innovations in the 9th edition of the Antithrombotic Therapy and Prevention of Thrombosis guidelines. To minimize length, the printed version includes this summary, an introduction, methods article, and recommendations from each article embedded in the table of contents. The full online version contains narrative summaries and evidence tables supporting over 600 recommendations across 9 articles. The executive summary successfully highlights the efforts taken to balance brevity with comprehensive coverage of antithrombotic therapy.
Anticoagulation
This document discusses oral anticoagulants and hand surgery. It presents several case studies and findings that show elective hand surgery can be performed safely in patients taking oral anticoagulants like warfarin as long as their INR is below 3.0. Minor bleeding complications were observed but were consistent with minor surgical procedures. The studies found stopping anticoagulation therapy before hand surgery is unnecessary and can increase risks from discontinuing important long-term medications. Clinical judgement should be used to determine risks for individual patients.
Primary angioplasty
The document discusses strategies for early treatment of acute myocardial infarction. It provides evidence that pre-hospital thrombolytic therapy can significantly reduce mortality rates compared to in-hospital thrombolytic therapy by reducing treatment delays. Studies show administering thrombolysis within 30-60 minutes of symptoms onset can save 11-60 lives per 1000 patients. Combined strategies using both pre-hospital thrombolysis and immediate angioplasty have demonstrated high rates of coronary reperfusion and good long-term outcomes.
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Summary of the recently published ACC consensus 2022 about the cardiovascular sequalae of Covid-19 infection
Lecture link: https://youtu.be/7JBG2v8YLpA
Role of nuclear medicine
CAD – leading cause of death
Cardiac SPECT – steady growth in last two decades & played an important role in clinical mangement
Radionuclide ventriculography (MUGA)
First pass studies
PET/CT
Novedades en el manejo de la IC Aguda
Ponencia presentada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor del Congreso Europeo de IC Atenas 2019’, realizado en la Casa del Corazón el 5 de junio de 2019
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Novedades en fisiopatología y diagnóstico de la IC
Ponencia presentada por el Dr. José Manuel García Pinilla en el directo online ‘Highlights del congreso HFA 2018: una mirada a Europa’, realizado el 15 de junio de 2018 en la XV Reunión Anual de la Sección de Insuficiencia Cardiaca de la SEC en Toledo.
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The DANISH trial investigated whether implantable cardioverter-defibrillators (ICDs) improve outcomes for patients with non-ischemic cardiomyopathy (NICMP) receiving optimal medical therapy including cardiac resynchronization therapy (CRT) when needed. The trial found that ICDs did not provide an overall survival benefit but did halve the risk of sudden cardiac death, with younger patients experiencing mortality benefit from ICDs. The results have led some clinicians to consider CRT without defibrillation first for NICMP patients and to more carefully select those who may benefit from ICDs based on age and risk factors. Ongoing research aims to identify better markers beyond ejection fraction to predict arrhythmic risk
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This document summarizes information on device therapy for congestive heart failure, including cardiac resynchronization therapy (CRT). It discusses:
1) The prevalence and mortality rates of heart failure in the US. Up to 30% of CHF patients have intraventricular conduction delays which increase mortality.
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3) Clinical trials that demonstrated the benefits of CRT including increased exercise capacity, quality of life, and decreased hospitalizations and mortality.
4) Anatomical challenges of CRT implantation via the coronary sinus and risks of the procedure. Proper lead placement is important to reduce asynchrony.
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Traditionally, radiation-induced cardiotoxicity has been studied using cardiac radiation doses rather than functional imaging. We developed artificial intelligence (AI) models based on novel cardiac delta radiomics using pre- and post-treatment FDG-PET/CT scans to predict overall survival in lung cancer patients undergoing radiotherapy. We identified four clinically relevant delta radiomics features with the AI prediction models. The best model achieved an AUC of 0.91 on the training set and 0.87 on the test set. We are a pioneering group in AI for functional cardiac imaging. If validated, this approach will enable to use standard PET/CT scans as functional cardiac imaging with good predictive AUC for OS, as well as provide automated methods to provide functional cardiac information for clinical outcome prediction AI in lung cancer patients.
PCI & AimRadial 2018 | FFR-CT - Colin Berry
PCI & AimRadial 2018 | FFR-CT - Colin BerryInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a presentation on CT-derived fractional flow reserve (FFR-CT). It discusses how FFR-CT increases the positive predictive value of coronary CT angiography (CTCA). Several landmark studies are summarized that evaluated the diagnostic accuracy of FFR-CT compared to CTCA. The PACIFIC trial findings showing high diagnostic accuracy of FFR-CT are described. Ongoing and upcoming clinical trials using FFR-CT like PRECISION and DECISION are mentioned. Novel applications of FFR-CT for biomechanics analysis and PCI planning are presented. Finally, new methods like user-generated CT-FFR that may reduce processing time are introduced, though accuracy needs further evaluation.Foro Epic _ Zero-CIN approach in patients with advanced CKD undergoing PCI
By Lorenzo Azzalini MD PhD MSc, Interventional Cardiology Division San Raffaele Hospital, Milan, Italy for foroepic.org
Alpheus trial ppt
The ALPHEUS trial compared ticagrelor to clopidogrel in reducing periprocedural myocardial injury in 1900 stable coronary patients undergoing high-risk elective PCI. Patients received a loading dose of either ticagrelor 180mg or clopidogrel 300-600mg before PCI, followed by 30 days of maintenance therapy. The primary outcome of periprocedural MI or major myocardial injury within 48 hours did not differ between groups. No differences were found in secondary outcomes including death or MI at 30 days. Ticagrelor did not increase major bleeding but was associated with more minor bleeding and dyspnea. The study concluded that higher platelet inhibition from ticagrelor did not translate to reduced per
Espessamento medio intimal carótidal trials
Carotid intima-media thickness (CIMT) is a measure of subclinical atherosclerosis that can be assessed noninvasively using ultrasound. CIMT has been shown to be related to traditional cardiovascular risk factors and predicts future cardiovascular events. Several studies have found that therapies which slow the progression of CIMT, such as statins, antihypertensives, and lifestyle changes, can reduce cardiovascular risk. However, CIMT is an imperfect surrogate and definitive outcomes trials are still needed to determine the clinical impact of therapies that affect CIMT progression.
Recent publications, key points from this year
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Carlo Di Mario, Florence, Italy
10th Experts „Live“ CTO Workshop - Day1
Carotid stenting
Endovascular approach to cartoid stenosis, Carotid stenosis clinical approach, presentation, imaging assessment, treatment options, endartectomy vs stenting, preop, intraop and post op managment, technique of carotid stenting, outcome, trails for stenting, follow up. Endovascular technique, stents available, embolic protection device
Carotid stenosis
This document discusses carotid artery stenosis, which can cause transient ischemic attacks (TIAs) or stroke. It presents 5 case studies of patients who presented with symptoms related to carotid stenosis. The key points are that carotid stenting can effectively treat symptomatic stenosis and reduce the risk of future strokes. However, stenting is not recommended for complete carotid occlusions seen on angiography. Medical management of associated conditions like diabetes and hypertension is also important. The timing of stenting depends on whether the patient presents with TIA versus an acute stroke.
Key changes in the field of cardiac arrhythmias in the past 2 years - Dr Pipi...
Dr Pipin Kojodjojo share more on the topic, key changes in the field of cardiac arrhythmias in the past 2 years.
Visit our website www.ahvc.com.sg for more info.
Presentation dec 17 aaps by eee
Presented by:
Emmanuel E. Egom, MSc, MD, PhD, MRCP (UK)
At the Academy of Applied Pharmaceutical Sciences (AAPS) in Toronto, Canada
12/19/2014
Similar to Latest Trials on CAD from 2020 ESC Congress (20)
Novedades en fisiopatología y diagnóstico de la IC
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Should we implant icd only in some patients with nicmp (cons)
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Impact of Newer Glucose-Lowering Agents in CVD & HF , and Novel Therapeutic Strategies
Han Naung Tun
MBBS, MD, FACTM, FACC, FESC
UVM Medical Centre
Larner College of Medicine , University of Vermont ,VT , USA
Coronary Artery Disease in Heart Failure : What We Have Learned and the Horizon
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By Dr Han Naung Tun, MBBS, MD, FACC, FESC
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Tips & Tricks ,and an EACVI Expert Consensus Document
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Therapy for Coronavirus Infection
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OF TREATMENT IN THE
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Sudden cardiac death and cardiogenic shock a team approach to save heart and brain by Dr Han Naung Tun
How To Recognise and Manage a Pre Shock Setting
This document discusses the recognition and management of pre-shock in the context of anterior ST-elevation myocardial infarction (STEMI). Pre-shock, also known as SCAI shock stages A-B, involves persistent hemodynamic compromise without fully meeting shock criteria and these patients are prone to rapid deterioration. The case describes a 65-year-old man with anterior STEMI who did not improve after percutaneous coronary intervention on the culprit lesion, meeting some but not all criteria for cardiogenic shock. Invasive hemodynamic monitoring showed features of pre-shock and upfront use of an intra-aortic balloon pump provided immediate hemodynamic support, preventing further deterioration. Early recognition of pre-shock using both clinical and invasive parameters can guide
Top Five Clinical Trials of PCI in 2019
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#ESC
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CMR (basic and application)
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help enhance one's emotional well-being and mental clarity.
Cardio oncology
This document discusses cardio-oncology, which focuses on the cardiovascular side effects of cancer treatments. It provides background on the development of cardio-oncology as a field and explains why cardiovascular disease and cancer are important to discuss together. The document then outlines several possible cardiovascular complications from cancer therapies, including myocardial dysfunction/heart failure, coronary artery disease, arrhythmias, hypertension, thromboembolic disease, and others. It emphasizes the importance of monitoring patients for these side effects during and after treatment.
Pre operative assessment of patient with liver disease
The patient is a 55-year-old male with liver cirrhosis and a history of empyema gallbladder who is scheduled for an elective cholecystectomy. Pre-operative assessments found elevated liver enzymes and signs of portal hypertension on ultrasound. The patient's MELD score placed him at moderate to high risk for surgery. Pre-operative optimization and risk stratification were performed, and the cholecystectomy was carried out with monitoring and treatment for liver disease and infection.
Cardiac CT Angiography to detect Myocardial Bridging
CTCA is a reliable non-invasive tool for detecting myocardial bridging in coronary artery disease. [The study] found an 8.2% frequency of myocardial bridging in 219 patients with coronary artery disease who underwent CTCA. CTCA allows for visualization of the length and depth of the bridging artery and measurement of stenosis. While myocardial bridging can be clinically significant when associated with hemodynamic changes, in most cases it remains asymptomatic. CTCA is an emerging alternative to other invasive tests for diagnosing myocardial bridging.
Heart Failure Preserved EF
1) Current treatments for HFpEF have not been shown to reduce morbidity or mortality, though trials are investigating new drug classes like ARNIs, soluble guanylate cyclase stimulators, and SGLT2 inhibitors.
2) Lifestyle modifications including exercise training, weight loss, and salt restriction may help symptoms. Exercise training in particular may improve exercise capacity.
3) Screening for underlying causes like myocardial ischemia, atrial fibrillation, amyloidosis, and treating associated conditions is recommended. The ATTR-ACT trial found tafamidis reduced cardiovascular hospitalizations and mortality in transthyretin amyloid cardiomyopathy.
Universal Definition of Myocardial Infarct
1) The document summarizes the 4th Universal Definition of Myocardial Infarction from 2018, outlining 5 types of MI (myocardial infarction).
2) It describes the criteria for each type of MI, including Type 1 due to plaque rupture, Type 2 due to oxygen supply/demand imbalance, and Type 3 where the patient dies before biomarkers can be obtained.
3) It also discusses MI associated with procedures like PCI (Type 4) and CABG (Type 5), and conditions like MINOCA where the coronary arteries are non-obstructive.
Thrombolysis and thrombectomy for acute ischaemic stroke
Reperfusion by intravenous thrombolysis or endovascular
mechanical thrombectomy improves functional outcomes
after stroke, but benefit for both treatment modalities is highly
time-dependent. Maximum benefit requires minimisation
of onset-to-treatment times. The safety and efficacy of IV
rtPA is established across a broad range of clinical scenarios.
Endovascular treatment now offers greatly improved outcome
among patients with poor response to IV rtPA but efficacy
has been established only in the context of highly organised
neurovascular interventional services.
40 years anniversary of PCI
This document provides a history and timeline of cardiac catheterization and percutaneous coronary intervention (PCI):
- In 1929, Werner Forssmann performed the first human cardiac catheterization on himself in Germany, though it was very painful. He shared the 1956 Nobel Prize for this work.
- In 1958, William Sones performed the first selective coronary angiogram, inadvertently discovering coronary anatomy.
- In 1977, Andreas Gruentzig developed the first functioning balloon catheter and performed the first successful non-operative coronary artery dilation.
- Major advances over the subsequent decades included over-the-wire balloon technology, coronary stenting, drug-eluting stents, and treatment of in-stent rest
Biomarkers in Coronary Artery Disease
- Biomarkers such as troponins, copeptin, and natriuretic peptides have become indispensable diagnostic tools in cardiology over the past 60 years.
- Troponins are the gold standard for diagnosing myocardial infarction, while copeptin allows for very early rule-out of MI.
- New biomarkers continue to be discovered through advances in genomics, epigenetics, and other 'omics' fields, with microRNAs showing promise to improve risk stratification and precision medicine for cardiovascular disease.
- Biomarkers have transformed cardiology practice and decision-making, with troponins in particular demonstrating their ability to guide therapies and intervention timing for conditions like ACS.
Hyperkalemia
This document discusses hyperkalemia (high potassium levels), including its causes, effects on the heart, diagnosis, and treatment. It describes a case report of a 69-year-old woman who experienced hyperkalemia after dialysis. Her symptoms included abdominal pain, fatigue, and arrhythmia. Treatment involved calcium, insulin, glucose, and emergent dialysis to lower her potassium level. The document then provides details on potassium regulation in the body, effects of high potassium on heart function, electrocardiogram changes seen with hyperkalemia, common causes, and approaches for treating acute hyperkalemia including membrane stabilization, promoting potassium influx, and potassium removal methods like dialysis or sodium polystyrene sulfonate.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
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1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Latest Trials on CAD from 2020 ESC Congress
- 1. Latest Trials on CAD from 2020 ESC Congress 2020, Nov Dr Han Naung Tun, MBBS, MD Cardiovascular Physician-scientist ESC Clinical and Research Working Group
- 2. • LoDoCo2 Trial: low-dose colchicine reduced the risk of major cardiovascular events in patients with CAD • ATPCI: Trimetazidine in Angina Patients With Recent Successful Percutaneous Coronary Intervention • RAPID CTCA :Early Coronary CT Angiography in Patients With Suspected or Provisionally Diagnosed Acute Coronary Syndrome • OCT and MRI Find an MI Cause in 85% of Women With MINOCA: HARP
- 3. LoDoCo2 Trial: low-dose colchicine reduced the risk of major cardiovascular events in patients with CAD Stefan M. Nidorf et al , NEJM , 2020 ATPCI: Trimetazidine in Angina Patients With Recent Successful Percutaneous Coronary Intervention ATPCI trial Trimetazidine in patients with angina after successful PCI shows no benefit Roberto Ferrari et al, ATPCI Trial, Lancet 2020
- 4. Early Coronary CT Angiography in Patients With Suspected or Provisionally Diagnosed Acute Coronary Syndrome - RAPID CTCA RAPID CTCA Trial investigators OCT and MRI Find an MI Cause in 85% of Women With MINOCA: HARP RAPID-CTCA: Early CTCA in intermediate/high- risk pts with suspected ACS at ED -No difference in all- cause death/subsequent MI -No effect on the overall Rx & prevention of ACS or one-year outcomes ~50% non-obstructive CAD The findings support a role for OCT on top of CMR, already urged by guidelines. How outcomes might change remains unclear Reynolds HR at al, MINOCA HARP, Circulation 2020
- 6. Thank You