Severe Left Main Coronary Artery Disease with Early Graft Failure - Sathish Parasuraman
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ACI 2018 Best of the Young - Severe Left Main Coronary Artery Disease with Early Graft Failure - Sathish Parasuraman
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Pioneer hf
Pioneer HF trial in patients with Acute decompensated heart failure started on angiotensin receptor neprilysin inhibitor
Arni
Sacubitril is a neprilysin inhibitor that is used in combination with valsartan for the treatment of heart failure. The combination drug sacubitril/valsartan inhibits neprilysin and blocks the angiotensin receptor. It was shown in the PARADIGM-HF trial to reduce cardiovascular death and heart failure hospitalizations compared to enalapril. Current guidelines recommend sacubitril/valsartan as a replacement for ACE inhibitors or ARBs in patients with HFrEF who are already on such therapy.
Mixed results for heart failure therapies, journel club
1. A study compared the angiotensin receptor–neprilysin inhibitor LCZ696 to enalapril in patients with heart failure and reduced ejection fraction. LCZ696 was superior to enalapril in reducing risks of death and hospitalization for heart failure.
2. A trial investigated spironolactone in patients with heart failure and preserved ejection fraction. Spironolactone did not significantly reduce the primary outcome but did lower the risk of hospitalization for heart failure. It increased hyperkalemia but with monitoring, serious adverse events were similar to placebo.
3. A study examined intravenous ferric carboxymaltose in patients with heart failure, reduced
My stuff
The document discusses using BNP or NT-proBNP blood tests to screen for heart failure in primary care settings. It finds that NT-proBNP performed better than BNP in identifying patients with left ventricular systolic dysfunction. A cutoff of 150 pg/ml for NT-proBNP provided a high negative predictive value of 97.3%, avoiding unnecessary referrals while missing only one mild case of heart failure. The document proposes a study to evaluate implementing NT-proBNP screening in primary care practices to guide referrals for suspected heart failure.
3 dan atar - rate versus rhythm control in af
Professor Dan Atar presented on the CABANA trial, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The trial involved over 4,000 patients across 140 centers in 10 countries. The primary endpoint was all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest. The trial found no difference in these clinical outcomes between the catheter ablation and drug therapy groups. However, catheter ablation was found to be an effective treatment for reducing symptoms in patients with atrial fibrillation. The trial supports current guidelines that catheter ablation should be considered for symptomatic patients after failed medical treatment.
Heart failure: From Evidence To Clinical Care
It includes pathophysiology, classification and treatment of heart failure according to landmark clinical trials for established medications as well as for novel treatment molecules like ARNI
Rtpa azhar kappil
Tissue plasminogen activator (tPA) breaks down blood clots and is used to treat ischemic stroke. It works by converting plasminogen to plasmin, the main enzyme responsible for clot breakdown. tPA can be used to treat stroke, pulmonary embolism, and myocardial infarction. For stroke treatment, tPA must be administered intravenously within 3 hours of symptom onset for eligible patients, who must be screened for risks of intracranial bleeding. Precautions are taken to monitor the patient's neurological status and control blood pressure during and after tPA infusion to minimize bleeding risks.
Bruchanski final x
- Stroke is a major cause of death and disability in the US, with nearly 800,000 new cases each year.
- Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) can help restore blood flow for acute ischemic stroke if administered within 3-4.5 hours of symptom onset.
- Several clinical trials showed that rt-PA administered within 3 hours of symptoms increased the likelihood of minimal or no disability compared to placebo, though it also increased the risk of intracranial hemorrhage.
Recommended
Pioneer hf
Pioneer HF trial in patients with Acute decompensated heart failure started on angiotensin receptor neprilysin inhibitor
Arni
Sacubitril is a neprilysin inhibitor that is used in combination with valsartan for the treatment of heart failure. The combination drug sacubitril/valsartan inhibits neprilysin and blocks the angiotensin receptor. It was shown in the PARADIGM-HF trial to reduce cardiovascular death and heart failure hospitalizations compared to enalapril. Current guidelines recommend sacubitril/valsartan as a replacement for ACE inhibitors or ARBs in patients with HFrEF who are already on such therapy.
Mixed results for heart failure therapies, journel club
1. A study compared the angiotensin receptor–neprilysin inhibitor LCZ696 to enalapril in patients with heart failure and reduced ejection fraction. LCZ696 was superior to enalapril in reducing risks of death and hospitalization for heart failure.
2. A trial investigated spironolactone in patients with heart failure and preserved ejection fraction. Spironolactone did not significantly reduce the primary outcome but did lower the risk of hospitalization for heart failure. It increased hyperkalemia but with monitoring, serious adverse events were similar to placebo.
3. A study examined intravenous ferric carboxymaltose in patients with heart failure, reduced
My stuff
The document discusses using BNP or NT-proBNP blood tests to screen for heart failure in primary care settings. It finds that NT-proBNP performed better than BNP in identifying patients with left ventricular systolic dysfunction. A cutoff of 150 pg/ml for NT-proBNP provided a high negative predictive value of 97.3%, avoiding unnecessary referrals while missing only one mild case of heart failure. The document proposes a study to evaluate implementing NT-proBNP screening in primary care practices to guide referrals for suspected heart failure.
3 dan atar - rate versus rhythm control in af
Professor Dan Atar presented on the CABANA trial, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The trial involved over 4,000 patients across 140 centers in 10 countries. The primary endpoint was all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest. The trial found no difference in these clinical outcomes between the catheter ablation and drug therapy groups. However, catheter ablation was found to be an effective treatment for reducing symptoms in patients with atrial fibrillation. The trial supports current guidelines that catheter ablation should be considered for symptomatic patients after failed medical treatment.
Heart failure: From Evidence To Clinical Care
It includes pathophysiology, classification and treatment of heart failure according to landmark clinical trials for established medications as well as for novel treatment molecules like ARNI
Rtpa azhar kappil
Tissue plasminogen activator (tPA) breaks down blood clots and is used to treat ischemic stroke. It works by converting plasminogen to plasmin, the main enzyme responsible for clot breakdown. tPA can be used to treat stroke, pulmonary embolism, and myocardial infarction. For stroke treatment, tPA must be administered intravenously within 3 hours of symptom onset for eligible patients, who must be screened for risks of intracranial bleeding. Precautions are taken to monitor the patient's neurological status and control blood pressure during and after tPA infusion to minimize bleeding risks.
Bruchanski final x
- Stroke is a major cause of death and disability in the US, with nearly 800,000 new cases each year.
- Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) can help restore blood flow for acute ischemic stroke if administered within 3-4.5 hours of symptom onset.
- Several clinical trials showed that rt-PA administered within 3 hours of symptoms increased the likelihood of minimal or no disability compared to placebo, though it also increased the risk of intracranial hemorrhage.
Presentation1
1) The document discusses acute kidney injury (AKI) in patients with acute coronary syndrome (ACS). AKI is a complex disorder characterized by early worsening of renal function and can range from a minimal creatinine increase to anuric renal failure.
2) The definitions and criteria for AKI, including RIFLE, AKIN, and KDIGO, are reviewed. The reported incidence of AKI in ACS patients ranges widely from 5-55% depending on the criteria and population studied.
3) AKI severity is independently associated with increasing short and long-term morbidity and mortality. Both transient and sustained AKI may favor the development of chronic kidney disease.
Pediatrics hypertension
This document provides information on pediatric hypertension, including definitions, etiology, measurement, management, and follow-up. It defines normal, elevated, and hypertensive blood pressure levels based on age and sex. Primary hypertension is most common and often associated with overweight or family history, while secondary hypertension is usually due to renal disease. Treatment involves non-pharmacological measures initially, with drugs like ACE inhibitors added if goals are not met. Follow-up assessments every 4-6 weeks are recommended after treatment begins.
Role of vascular surgeon in stroke
The document discusses carotid artery disease and treatment options. It notes that the brain receives blood supply from the carotid and vertebral arteries. Carotid endarterectomy (CE) is recommended for patients with 70-99% stenosis to prevent stroke, while those with less than 50% stenosis are treated medically. Risks of CE include perioperative stroke (7.4% risk), nerve injury, hematoma, and hyperperfusion syndrome. CE is usually performed under general anesthesia to maintain cerebral blood flow and allow smooth recovery assessment. Strict blood pressure control is needed after surgery to prevent hyperperfusion syndrome. Carotid stenting is an alternative for difficult surgical access or medical unfitness for surgery.
Optiminsation after ADHF
The document provides guidance on optimizing treatment for patients hospitalized with acute decompensated heart failure (ADHF). It recommends addressing exacerbating factors, achieving optimal volume status and transitioning from IV to oral diuretics before discharge. Post-discharge, initiating ACE inhibitors/ARNI, beta-blockers, and mineralocorticoid receptor antagonists is essential to prevent readmission, along with lifestyle counseling and follow-up. The PARADIGM-HF and PIONEER HF trials support in-hospital initiation of sacubitril-valsartan for eligible patients to reduce biomarkers and clinical outcomes. Careful titration of medications is important to avoid complications.
Biomarkers activity and the effect of nt pro bnp guided therapy in high risk ...
This study evaluated 103 high-risk chronic heart failure patients after acute decompensation who were randomized to either NT-proBNP guided therapy or standard therapy. Biomarkers including NT-proBNP, sST2, copeptin, galectin-3, and troponin T were measured at baseline, 3 months, and 6 months. NT-proBNP guided therapy aimed to reduce NT-proBNP levels by at least 50% from baseline. NT-proBNP guided therapy resulted in greater reductions in biomarkers and lower rates of cardiovascular events compared to standard therapy over 10 months of follow-up. Biomarker changes correlated with improvements in left ventricular function and filling pressures, suggesting guided
2018 guidelines for management of patients with acute.pptx new
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Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
Intravenous thrombolysis for acute ischemic stroke
This case report describes a 76-year-old female patient who presented with acute ischemic stroke while taking rivaroxaban for atrial fibrillation. Magnetic resonance imaging showed an infarction in the left middle cerebral artery territory. Despite an elevated INR of 1.51, the patient underwent intravenous thrombolysis with rt-PA 210 minutes after symptom onset due to a recent dose of rivaroxaban. She recovered completely without hemorrhage. This case highlights the need for further research on thrombolysis safety in patients taking rivaroxaban, as current tests may not accurately reflect anticoagulation levels from new oral anticoagulants like rivaroxaban. Sensitive bedside coagulation testing is urgently
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This document discusses recent advances in the medical management of heart failure. It begins by describing the types of heart failure and the historically available treatment options of diuretics and digoxin. It then discusses neurohormonal blockers that have been effective in reducing morbidity and mortality for HFrEF. The document reviews evidence for drugs like hydralazine/isosorbide and goes on to describe several novel drug categories and agents that may further improve heart failure treatment, such as neprilysin inhibitors, soluble guanylate cyclase stimulators, calcium sensitizers, and metabolic modulators.
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This document discusses the case of an 83-year-old man with ischemic and valvular cardiomyopathy who presented with acute decompensated heart failure. He underwent transcatheter aortic valve replacement (TAVR) with improvement in symptoms initially. However, follow-up echocardiography showed persistence of severe mitral regurgitation. The patient's options for treatment of residual mitral regurgitation are discussed, including intensifying medical management, surgical mitral valve replacement, or percutaneous mitral valve repair with a MitraClip procedure.
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Clinical Pearls in Cardiology
This patient has class III heart failure with an ejection fraction of 28% and was recently hospitalized for decompensated heart failure. She has been adherent to guideline directed medical therapy including diuretics, beta blockers, ACE inhibitors, and has a cardiac resynchronization device. Given her recent hospitalization and high BNP, adding an aldosterone inhibitor would be a reasonable next step to further optimize her medical management.
MANAGEMENT OF ANTERIOR WALL MI WITH SHOCK IN A NON PCI CENTER
Cardiogenic shock is a major cause of death in AMI patients and requires immediate diagnosis and management. The document outlines the definition, causes, predictive indicators, medical and interventional management of cardiogenic shock. It recommends emergency revascularization with PCI or CABG for suitable patients irrespective of time delay from MI onset. For those unsuitable for revascularization, fibrinolytic therapy is recommended if no contraindications. Intra-aortic balloon pump can be useful for hemodynamically unstable patients while alternative devices may be considered for refractory shock.
Cabg indications, conduits and results
This document discusses coronary artery bypass grafting (CABG), including indications, conduits used, and postoperative results. CABG is indicated for ischemic heart disease to relieve symptoms and improve survival. Common conduits are the internal thoracic artery, radial artery, and saphenous vein. Postoperative complications can include bleeding requiring reexploration (2-6% of cases), perioperative myocardial infarction (2-10% of first time CABG), neurologic events like delirium (30-80% at discharge), and stroke (incidence of 1-3%). Long-term patency of conduits is highest for the internal thoracic artery at 10 years.
Kumpulan slide chf, stemi, nstemi, uap
The morning report summarizes 6 patients admitted to the cardiology department. Patient 1 has congestive heart failure and a history of coronary artery disease. Patient 2 has unstable angina and diabetes. Echocardiogram shows normal left ventricular function. Patient 3 has unstable angina, a history of smoking, and previous coronary angiography showing 3-vessel disease.
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Perioperative optimisation for surgery
This patient presented with cholelithiasis and was scheduled for lap cholecystectomy surgery. However, he had severely elevated blood pressure of 230/120 mm Hg and low serum potassium of 2.7 mEq/L. His medications included propranolol and hydrochlorothiazide. Pre-operative optimization and control of blood pressure and electrolyte abnormalities is important before elective surgery to reduce perioperative cardiovascular and renal risks.
Management of no reflow
No-reflow occurs when there is a lack of reperfusion to the myocardium after successful coronary recanalization and is defined as inadequate perfusion without angiographic evidence of vessel obstruction. It occurs in 0.6-3.2% of PCI cases and is associated with increased risk of LV dysfunction, remodeling, arrhythmias, heart failure and cardiac rupture. Diagnosis is typically done using myocardial contrast echocardiography or cardiac MRI. Treatment focuses on improving perfusion and includes vasodilators like adenosine, antithrombotics, mechanical strategies like thrombectomy, and preventing no-reflow through measures like pre-conditioning.
Acute renal failure
This document discusses 5 cases of acute renal failure (ARF).
Case 1 involved a diabetic man who developed ARF likely due to dehydration and receipt of a nephrotoxic antibiotic. Case 2 involved ARF from ACE inhibitor use in a patient with renal artery stenosis. Case 3 involved hyperkalemic ARF from NSAID and diuretic use in a patient with sepsis. Case 4 described rapidly progressive glomerulonephritis. Case 5 involved post-renal ARF from bilateral ureteric stones causing obstruction.
The document discusses approaches to evaluating and diagnosing different types of ARF - pre-renal, intrarenal, and post-renal. It provides
BLOCK HF trial
The document summarizes several studies on cardiac resynchronization therapy (CRT) for heart failure. The Block HF trial found that CRT was superior to right ventricular pacing alone in reducing death and heart failure-related events in patients with heart failure, left ventricular dysfunction, and AV block. Subsequent trials like COMPANION, CARE-HF, REVERSE, and MADIT-CRT also demonstrated benefits of CRT over medical therapy alone in improving outcomes like mortality, hospitalizations, quality of life and left ventricular function. Updated guidelines have expanded the use of CRT to patients in NYHA class I/II with left bundle branch block and QRS duration over 150ms.
Cardiac Investigation In Heart Failure
This document discusses the use of B-type natriuretic peptide (BNP) testing in the evaluation of heart failure. It describes the physiology of BNP release and important caveats when interpreting BNP levels. Landmark trials are summarized that demonstrate the clinical utility of BNP for diagnosing heart failure, risk stratification of patients, and guiding heart failure management. The document recommends ordering BNP testing to help diagnose heart failure in patients with ambiguous signs and symptoms, as well as to track changes in patients' clinical status and risk over time.
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Presentation1
1) The document discusses acute kidney injury (AKI) in patients with acute coronary syndrome (ACS). AKI is a complex disorder characterized by early worsening of renal function and can range from a minimal creatinine increase to anuric renal failure.
2) The definitions and criteria for AKI, including RIFLE, AKIN, and KDIGO, are reviewed. The reported incidence of AKI in ACS patients ranges widely from 5-55% depending on the criteria and population studied.
3) AKI severity is independently associated with increasing short and long-term morbidity and mortality. Both transient and sustained AKI may favor the development of chronic kidney disease.
Pediatrics hypertension
This document provides information on pediatric hypertension, including definitions, etiology, measurement, management, and follow-up. It defines normal, elevated, and hypertensive blood pressure levels based on age and sex. Primary hypertension is most common and often associated with overweight or family history, while secondary hypertension is usually due to renal disease. Treatment involves non-pharmacological measures initially, with drugs like ACE inhibitors added if goals are not met. Follow-up assessments every 4-6 weeks are recommended after treatment begins.
Role of vascular surgeon in stroke
The document discusses carotid artery disease and treatment options. It notes that the brain receives blood supply from the carotid and vertebral arteries. Carotid endarterectomy (CE) is recommended for patients with 70-99% stenosis to prevent stroke, while those with less than 50% stenosis are treated medically. Risks of CE include perioperative stroke (7.4% risk), nerve injury, hematoma, and hyperperfusion syndrome. CE is usually performed under general anesthesia to maintain cerebral blood flow and allow smooth recovery assessment. Strict blood pressure control is needed after surgery to prevent hyperperfusion syndrome. Carotid stenting is an alternative for difficult surgical access or medical unfitness for surgery.
Optiminsation after ADHF
The document provides guidance on optimizing treatment for patients hospitalized with acute decompensated heart failure (ADHF). It recommends addressing exacerbating factors, achieving optimal volume status and transitioning from IV to oral diuretics before discharge. Post-discharge, initiating ACE inhibitors/ARNI, beta-blockers, and mineralocorticoid receptor antagonists is essential to prevent readmission, along with lifestyle counseling and follow-up. The PARADIGM-HF and PIONEER HF trials support in-hospital initiation of sacubitril-valsartan for eligible patients to reduce biomarkers and clinical outcomes. Careful titration of medications is important to avoid complications.
Biomarkers activity and the effect of nt pro bnp guided therapy in high risk ...
This study evaluated 103 high-risk chronic heart failure patients after acute decompensation who were randomized to either NT-proBNP guided therapy or standard therapy. Biomarkers including NT-proBNP, sST2, copeptin, galectin-3, and troponin T were measured at baseline, 3 months, and 6 months. NT-proBNP guided therapy aimed to reduce NT-proBNP levels by at least 50% from baseline. NT-proBNP guided therapy resulted in greater reductions in biomarkers and lower rates of cardiovascular events compared to standard therapy over 10 months of follow-up. Biomarker changes correlated with improvements in left ventricular function and filling pressures, suggesting guided
2018 guidelines for management of patients with acute.pptx new
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Sheikh Khalifa bin zayed hospital muzaffarabad azad kashmir.
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Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
Intravenous thrombolysis for acute ischemic stroke
This case report describes a 76-year-old female patient who presented with acute ischemic stroke while taking rivaroxaban for atrial fibrillation. Magnetic resonance imaging showed an infarction in the left middle cerebral artery territory. Despite an elevated INR of 1.51, the patient underwent intravenous thrombolysis with rt-PA 210 minutes after symptom onset due to a recent dose of rivaroxaban. She recovered completely without hemorrhage. This case highlights the need for further research on thrombolysis safety in patients taking rivaroxaban, as current tests may not accurately reflect anticoagulation levels from new oral anticoagulants like rivaroxaban. Sensitive bedside coagulation testing is urgently
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Similar to Severe Left Main Coronary Artery Disease with Early Graft Failure - Sathish Parasuraman
Advances in Medical Management of Heart Failure
This document discusses recent advances in the medical management of heart failure. It begins by describing the types of heart failure and the historically available treatment options of diuretics and digoxin. It then discusses neurohormonal blockers that have been effective in reducing morbidity and mortality for HFrEF. The document reviews evidence for drugs like hydralazine/isosorbide and goes on to describe several novel drug categories and agents that may further improve heart failure treatment, such as neprilysin inhibitors, soluble guanylate cyclase stimulators, calcium sensitizers, and metabolic modulators.
Pitfalls of mitral valve repair
This document discusses the case of an 83-year-old man with ischemic and valvular cardiomyopathy who presented with acute decompensated heart failure. He underwent transcatheter aortic valve replacement (TAVR) with improvement in symptoms initially. However, follow-up echocardiography showed persistence of severe mitral regurgitation. The patient's options for treatment of residual mitral regurgitation are discussed, including intensifying medical management, surgical mitral valve replacement, or percutaneous mitral valve repair with a MitraClip procedure.
Approach to cardio renal syndrome
This document discusses cardio-renal syndrome (CRS), beginning with four case studies. It then covers the classification of CRS into five types based on whether cardiac or renal dysfunction occurs first and the duration. The pathophysiology of each type is complex, involving neurohormonal activation and other factors beyond just low blood flow. Novel biomarkers provide more accurate assessment of kidney injury than serum creatinine alone. Current management includes diuretics, ACE inhibitors, and other therapies, but future directions may include ultrafiltration, vaptans, adenosine antagonists, and hypertonic saline. CRS indicates communication between the heart and kidneys, leading to worse outcomes, so accurate diagnosis and coordinated treatment are important
Clinical Pearls in Cardiology
This patient has class III heart failure with an ejection fraction of 28% and was recently hospitalized for decompensated heart failure. She has been adherent to guideline directed medical therapy including diuretics, beta blockers, ACE inhibitors, and has a cardiac resynchronization device. Given her recent hospitalization and high BNP, adding an aldosterone inhibitor would be a reasonable next step to further optimize her medical management.
MANAGEMENT OF ANTERIOR WALL MI WITH SHOCK IN A NON PCI CENTER
Cardiogenic shock is a major cause of death in AMI patients and requires immediate diagnosis and management. The document outlines the definition, causes, predictive indicators, medical and interventional management of cardiogenic shock. It recommends emergency revascularization with PCI or CABG for suitable patients irrespective of time delay from MI onset. For those unsuitable for revascularization, fibrinolytic therapy is recommended if no contraindications. Intra-aortic balloon pump can be useful for hemodynamically unstable patients while alternative devices may be considered for refractory shock.
Cabg indications, conduits and results
This document discusses coronary artery bypass grafting (CABG), including indications, conduits used, and postoperative results. CABG is indicated for ischemic heart disease to relieve symptoms and improve survival. Common conduits are the internal thoracic artery, radial artery, and saphenous vein. Postoperative complications can include bleeding requiring reexploration (2-6% of cases), perioperative myocardial infarction (2-10% of first time CABG), neurologic events like delirium (30-80% at discharge), and stroke (incidence of 1-3%). Long-term patency of conduits is highest for the internal thoracic artery at 10 years.
Kumpulan slide chf, stemi, nstemi, uap
The morning report summarizes 6 patients admitted to the cardiology department. Patient 1 has congestive heart failure and a history of coronary artery disease. Patient 2 has unstable angina and diabetes. Echocardiogram shows normal left ventricular function. Patient 3 has unstable angina, a history of smoking, and previous coronary angiography showing 3-vessel disease.
CSA-AKI (1).pptx
This document summarizes a joint consensus report on acute kidney injury associated with adult cardiac surgery (CSA-AKI). CSA-AKI is a serious complication that increases mortality and the risk of chronic kidney disease. The consensus meeting had goals of generating recommendations to prevent and identify early AKI through discussions on biomarkers, goal directed therapy, ultrasound, and artificial intelligence. Acute kidney injury is defined and criteria, incidence, risk factors, prevention strategies like shortening bypass times and transfusions, and treatment approaches like dialysis are addressed. Current treatments focus on optimization of hemodynamics and avoiding nephrotoxins while research investigates vasopressin, oxygen delivery, and bundles of care.
Perioperative optimisation for surgery
This patient presented with cholelithiasis and was scheduled for lap cholecystectomy surgery. However, he had severely elevated blood pressure of 230/120 mm Hg and low serum potassium of 2.7 mEq/L. His medications included propranolol and hydrochlorothiazide. Pre-operative optimization and control of blood pressure and electrolyte abnormalities is important before elective surgery to reduce perioperative cardiovascular and renal risks.
Management of no reflow
No-reflow occurs when there is a lack of reperfusion to the myocardium after successful coronary recanalization and is defined as inadequate perfusion without angiographic evidence of vessel obstruction. It occurs in 0.6-3.2% of PCI cases and is associated with increased risk of LV dysfunction, remodeling, arrhythmias, heart failure and cardiac rupture. Diagnosis is typically done using myocardial contrast echocardiography or cardiac MRI. Treatment focuses on improving perfusion and includes vasodilators like adenosine, antithrombotics, mechanical strategies like thrombectomy, and preventing no-reflow through measures like pre-conditioning.
Acute renal failure
This document discusses 5 cases of acute renal failure (ARF).
Case 1 involved a diabetic man who developed ARF likely due to dehydration and receipt of a nephrotoxic antibiotic. Case 2 involved ARF from ACE inhibitor use in a patient with renal artery stenosis. Case 3 involved hyperkalemic ARF from NSAID and diuretic use in a patient with sepsis. Case 4 described rapidly progressive glomerulonephritis. Case 5 involved post-renal ARF from bilateral ureteric stones causing obstruction.
The document discusses approaches to evaluating and diagnosing different types of ARF - pre-renal, intrarenal, and post-renal. It provides
BLOCK HF trial
The document summarizes several studies on cardiac resynchronization therapy (CRT) for heart failure. The Block HF trial found that CRT was superior to right ventricular pacing alone in reducing death and heart failure-related events in patients with heart failure, left ventricular dysfunction, and AV block. Subsequent trials like COMPANION, CARE-HF, REVERSE, and MADIT-CRT also demonstrated benefits of CRT over medical therapy alone in improving outcomes like mortality, hospitalizations, quality of life and left ventricular function. Updated guidelines have expanded the use of CRT to patients in NYHA class I/II with left bundle branch block and QRS duration over 150ms.
Cardiac Investigation In Heart Failure
This document discusses the use of B-type natriuretic peptide (BNP) testing in the evaluation of heart failure. It describes the physiology of BNP release and important caveats when interpreting BNP levels. Landmark trials are summarized that demonstrate the clinical utility of BNP for diagnosing heart failure, risk stratification of patients, and guiding heart failure management. The document recommends ordering BNP testing to help diagnose heart failure in patients with ambiguous signs and symptoms, as well as to track changes in patients' clinical status and risk over time.
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Cardiology Case Presentation
This document presents a cardiology case of a 56-year-old Hispanic male with a history of heart failure, ischemic cardiomyopathy, myocardial infarctions, hypertension, and strokes who was transferred for outpatient IV antibiotics and cardiology consultation. The patient's medical history, medications, physical exam findings, assessments, and treatment plans are summarized. Discussion topics include the patient's heart failure stage, electrocardiogram and chest x-ray findings, and automatic implantable cardioverter-defibrillator.
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heart.pptx
Cardiac catheterization is an invasive procedure where a catheter is inserted into the heart via arteries or veins to perform diagnostic testing or interventions. It can be used to assess heart structure and function through angiography, assess blood flow and pressures, and treat conditions like coronary artery disease. Potential risks include bleeding, infection, arrhythmias, and contrast-induced kidney injury. Post-procedure care involves bed rest, monitoring for complications, and follow up. Other cardiac tests discussed include radionuclide imaging, electrophysiology studies, and coronary angiography.
LVAD in India, LVAD Implantation in India, LVAD II Final Output 20/10/2015
www.kewalkrishan.com or Call 91-9650300500 Dr. Kewal Krishan expert Surgeon for LVAD in India, LVAD Implantation in India, The left ventricular assist device, or LVAD, is a mechanical pump that is implanted inside a person's chest to help a weakened heart ventricle pump blood throughout the body.
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- 1. Severe Left Main Stem Coronary Disease with Early Graft Failure Dr Sathish Parasuraman ST7 Coronary Intervention Dr Deepak Garg Consultant Cardiologist Aberdeen Royal Infirmary • 47, Nepalese male • Hypercholesterolemia of 6.6 • NSTEMI Feb 2017 • Minimal Troponin raise, good LV function
- 2. After Heart Team Meeting: CABG as inpatient: (2 cardiologists involved) IMA – LAD, SVG- distal RCA (To PLV), SVG- OM
- 3. Angio sequence of RCA 2 months later: Presented with Unstable Angina of 2 weeks Normal LV function Beta-blocker, Nitrate, Calcium channel antagonist, addition of Nicorandil
- 4. Strategy! • Medical therapy • Repeat CABG-Case discussed in the Heart meeting, surgeons not keen on re-CABG • Coronary intervention – ? Antegrade approach – ? Retrograde approach CT coronary showed occluded LMS with ambiguous cap Coronary CTA 2 objectives: • To confirm flush occlusion of LMS ostium- ‘Ambiguous’ proximal cap. • To ascertain patency of LAD after (stenositic) IMA anastomosis
- 5. Heart Team • Medical therapy – Failed, rest symptoms • Repeat CABG – Patient and wife ‘scared’ and not keen at all – Declined by two surgeons • PCI – Ante-grade approach not a good option- No stump of LMS – CTA helpful – Retrograde approach planned. Discussion with patient
- 6. Plan of procedure • RCA- donor , retrograde visualisation from IMA ( RFA 8F) • Ostial PCI of RCA • RG Septal to LAD- mid or proximal vessel. • Snare RG3 in Aorta via IMA guide moved to Antegrade approach • Reconstruct LMS to AD, Cx
- 9. Wire was exchanged for an RG3 and snared out through a guide moved from IMA
- 11. Final result Asymptomatic, patient has returned to full time work
- 12. Points of interest Initial mode of re-vascularisation for non bifurcation LMCAD in a 47 year old Potential causes of early graft failure Secondary revascularization- modern techniques Secondary preventive pharmacology Follow up