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Posts Tagged ‘nstemi’

Transient ischemic attacks (TIA s) can it occur in coronary circulation?

Posted in cardiology- coronary care, My presentations, tagged , , , , , , on August 6, 2008| Leave a Comment »

Transient ischemic attacks are not exclusive to cerebral circulation.

Many such episodes can occur in coronary circulation also .

TIA of heart PPT presentation

Click here to download  tia-of-heart

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If aortic dissection is the most painful clinical condition why coronary dissection is least painful?

Posted in Cardiology -Interventional -PCI, tagged , , , , , , , , , , , , on July 19, 2008| 1 Comment »

Thousands of dissections happen in cath labs  all over the world every day  very rarely it is painful . The answer is not clear. Both have rich vasa nervorum. Aortic dissection  involves media and smooth muscle . Coronary dissection may also be a  equally painful  , probably we are not recognising it ! or we attribute   all  chest pain in ACS  to ischemia .

Deep dissections into the smooth muscle should be painful.  Type c nerve fibers carry pain signals from heart

Answers welcome.

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Is plaque fissure or rupture painful ?

Posted in cardiology- coronary care, tagged , , , , , , , on July 19, 2008| Leave a Comment »

Plaque fissure ,rupture and subsequent thrombois is the hallmark of acute coronary syndrome . Are these events painful ? We always attribute any chest pain in an ACS patient to ischemia of myocardium.Is that always true? Coronary artery also has a rich vasa nervorum that could be activated by plaque disruption.

Why  we need an answer to this question ?

We are triaging patients for early invasive apporach based on chestpain .

Many patients may be subjected to revascularisation process for an non ischemic coronary pain !

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How is LAD angina differnt from RCA angina ? Can we localise the “Angina related artery ” from the the type of chest pain ?

Posted in Cardiology - Clinical, Infrequently asked questions in cardiology (iFAQs), Tutorial in clinical cardiology, tagged , , , , , , , , , on July 2, 2008| 1 Comment »

How is LAD angina differnt from RCA angina ?

Can we localise the “Angina related artery ”  from the  the type of chest pain ?

Patients with stable  angia  many times have  multivessel CAD. There has been some correlation with radiation of anginal pain and the culprit artery.If the angina spreads to jaw or neck it is possibleit might indicate RCA(RIGHT coronary angina) but rarely it indicates LAD/LCX lesions. if the angina radiates to left shoulder it virtually ruels out a RCA disease

Source .Braunwald 1992 Edition

Dr.S.Venkatesan ., Madras medical college. Chennai.

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What is the optimal dose of clopidogrel in ACS ?

Posted in cardiology -Therapeutics, tagged , , , , on July 2, 2008| Leave a Comment »

Aspirin confusion spreads to clopidogrel !

It all started with 75 mg clopidogrel in CURE study  and others.

It went up to 150, 300, 600, and in some centres 900 mg.

No body knows how much clopidogrel optimally inhibits the platelet.

Aspirin had the same story three decades ago. It started from 40mg went up to 1200mg

and finally settled at 162mgs.

Why this confusion?

 It is because there is no simple platletlet function tests available in bedside.

and also the wide safety margin of this drug.At what level  clopidogrel  is unsafe

is also not clear !

Answers are expected soon .

 

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Is there a time window for intervention in unstable angina /NSTEMI ?

Posted in Cardiology-Coronary artery disese, tagged , , , , , , , , , , , , , on June 26, 2008| Leave a Comment »

                                   ACS   is the  most common cardiac emergency .  Management of STEMI is relatively straight forward.  The  only decision that to be taken is the  modality of reperfusion. (Primary PCI   or thrombolysis.) There is no need to risk stratify  STEMI on arrival. All STEMI patients are considered high risk on admission. Whereas  NSTEMI consists of  a heterogeneous  population. They need to be   triaged into low intermediate  or high risk categorizes on arrival.There is two management  approaches for unstable angina .All high risk UA should enter early invasive strategy . And low risk and intermediate risk group will get early conservative management. 

                                       The principle of management of  UA differ from STEMI in a fundamental way , as there is no issue of myocardial salvage in UA .The primary aim is to provide relief from pain and prevent an MI. So in the strict sense there is no time window in unstable angina /NSTEMI.

 

                                       But it is generally considered 48 hours is the time limit for an early invasive approach.If the patient has crossed this time there is apparently no great difference in outcome for conservative and invasive approach. 

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Why Abxicimab is very useful inside cath lab but dangerous outside cath lab ?

Posted in Uncategorized, tagged , , , , , , on June 18, 2008| Leave a Comment »

2b -3a antagonists have revolutinised ACS management .

But the irony is Reo pro is approved for use only  inside cath lab or on the way to cath lab ! when PCI is done . 

If PCI with stenting is planned,  then subsequently cancelled due to  minimal coronary lesion or spontaneous reperfusion  what will be the effect of Abxicimab on outcome ?

Message 1

Abxicimab (Reopro,Faximab)

Useful only if PCI and stenting is done.

Dont use it for regular managment of UA/NSTEMI

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