Archive for the ‘Cardiologt women’ Category

Reperfusion arrhythmia was described originally  in the thrombolytic era .

It can be any of the the following .

  • AIVR(Accelerated Idio Ventricular rhythm)
  • Sinus bradycardia (In Infero posterior MI )
  •  VF can occur as  Re-perfusion  arrhythmia.

Does these arrhythmia occur following primary PCI ?

It should  isn’t ? 

In fact it  must be  more pronounced  as we  believe PCI is far superior modality for reperfusion !

Busy Interventional  cardiologists  of the current era  either do not  look for it or fail to document it . These arrhythmias occurs only  with early Primary PCI (Say less than 2-3 hours) .If re-perfusion arrhythmias are  really less common with primary PCI , are we missing some thing ?



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What is  the most important factor that  will decide  the revascularsation following a  STEMI  ?

  1. Patient’s  symptoms
  2. Residual Ischemia documented by stress  test /Perfusion scan
  3. Presence of  significant  LV dysfunction
  4. Coronary anatomy and lesion profile
  5. Wealth  of the  patient (Insurance  limit  and  other  financial  resources )

Response  2  is   academically correct ,   but    practically  and politically   response 5  would be   the right one  for most cardiologists . At  any given day  ,  affordability and availability  of PCI  will prevail over all other factors  .

Affluence based cardiology

Image courtesey : Jupeter images

What is the  height of  inappropriateness in modern cardiac care ?

This world will never forgive the medical profession , if they do not fight  against  grossly inappropriate medical  care system especially in the life saving situations  .While one  cardiologist    just watches   a  left main disease patient  with unstable angina die peacefully in a Govt institution ,  while  another  patient with asymptomatic  distal PDA lesion gets a 3rd generation drug eluting stent in a  nearby corporate hospital !

Please note : Harm is the ultimate outcome in both rich and poor.One suffers with non availability while the other is the victim  of   affordability .

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Gynecologists  do have  interactions with cardiologists  frequently  in their day to day practice.In fact ,  in any big hospitals cardiologist consult  invariably happen every day . In our institute  fellows visit the maternity ward almost daily to give opinion   about a cardiac issues .  These are mainly emergencies like  breathless   rheumatic heart  patient  in labor , A DVT to R/O pulmonary embolism,  women  with prosthetic valve waiting for delivery, and a  women with LV dysfunction posted for hysterectomy  etc.

While it is common  for  our  Gynec colleagues to call us in  emergencies ,   and we do have a cardiac clinic every week ,  it is rare to discuss broad based practice  issues. There is little inter departmental  brain storming sessions.

Here is an excellent initiative from  European union where they have  created consensus document for reducing  cardiac risk  in peri menopausal  women.(http://eurheartj.oxfordjournals.org/content/28/16/2028.full.pdf+html)

The beauty of this document lies in the succinct practice points written in every  page .

In India , even though premier bodies like cardiological  society of  India  exits it rarely  considers bringing about such guidelines  in collaboration with other scientific bodies . ( To be  more precise  . . .they  do not have their own guidelines either ! )

I believe , FOGSI  (Federation of Obstetrics and gynecologists society of India ) is doing a much better job and they have created exclusive guidelines in O & G.

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