Learning Cardiology

 Case 1. A 23-year old gentleman presented with history of chest pain and shortness of breath.  This was the ECG at the time of presentation.  What are the findings? What is the diagnosis? Answer: ECG shows Sinus tachycardia and S1Q3T3 pattern.  S1Q3T3 pattern is a specific sign of acute pulmonary embolism. CTPA confirmed the diagnosis.   Patient underwent thrombolysis with Tenecteplase successfully with resolution of symptoms.

  Management of coronary artery perforation 1.       Balloon inflation for occlusion of vessel 2.       General circulatory support → Intravenous fluids and vasopressors 3.       Urgent pericardiocentesis if cardiac tamponade (may consider autotransfusion) 4.       Call anaesthetist and inform surgeons. Repeat angiogram ↓ Extravasation settled → Yes → Monitor patient ↓ No #        Large vessel perforation 1.       Prolonged balloon inflation 2.       Covered stent placement #        Small distal vessel perforation 1.       Embolization (fat, coils, thrombin, balloon fragment) 2.       Covered stent in main vessel over perforated branch origin

Peripartum Cardiomyopathy  (PPCM) •         Usually develops in last month of pregnancy or first 5 months post-delivery. •         Presents as heart failure with reduced ejection fraction (dilated cardiomyopathy) ↳        LV EF < 45%  •         PPCM is a diagnosis of exclusion. •         Risk factors → 1-      History of Hypertension, Pre-eclampsia 2-      Black women •         Incidence → 1 in 2000 live births. •         Management → 1.       Guideline directed medical therapy for HF- Beta-blockers Hydralazine plus isosorbide dinitrate  Diuretics 2.       Bromocriptine 3.       Low threshold for anticoagulation 4.       ACE inhibitors and ARBs are contraindicated before delivery. 5.       Safety of ARNI and SALT-2 inhibitors in not clear at present.   •         Mode of delivery: Vaginal delivery is preferred. •         If LV dysfunction persists, avoid future pregnancies. •         Prognosis → 1.       About half of the patients will recover. 2.       And half will have some degree

 Bempedoic Acid A novel nonstatin drug that inhibits cholesterol biosynthesis in liver. Prodrug → converted to active form in liver, not in muscles. # Mechanism of action → ATP-citrate lyase inhibitor. • No muscular side effects. • Does not worsen glycemic control • side effects → Hyperuricemia and gout  Slightly increased risk of tendon rupture ⇒ Major clinical trial - CLEAR wisdom and CLEAR Outcomes ⇒ Indications at present: 1. LDL not effectively reduced with statins -As additional therapy 2. Patients not tolerating stating due to side effects -As monotherapy

Cardiology MCQ Q. What is the mechanism of action of drug Bempedoic acid? A. ATP citrate lyase inhibitor B. HMG CoA reductase inhibitor C. Niemann–Pick C1-like 1 protein (NPC1L1) inhibitor D. PCSK9 inhibitor

 Cardiology MCQ Q. Which of the following leads is not an inferior lead in ECG? A. Lead II B. Lead III C. Lead aVF D. Lead aVR Click the button below to view answer Show answer Correct answer is option D. Lead aVR

What is the cause of ST changes and T wave inversions in this ECG? Should the patient be taken to Cath lab for coronary angiography? Show Answer These ST segment and T wave changes are secondary to left ventricular hypertrophy. There are classical features of left ventricular hypertrophy in this ECG which should not be missed. Hence, if the patient doesn't have any other features which suggest ischemia, then he should undergo evaluation for cause of left ventricular hypertrophy. The most common cause for left ventricular hypertrophy is hypertension.

Educational post Please have a look at the ECG shown below. Is this atrial tachycardia or atrial flutter? Show answer ECG definition of atrial flutter is atrial rate more than 240 bpm and no isoelectric line between p waves. Atrial tachycardia will have rate between 120 to 240 bpm with clear isoelectric line between p waves. However, these two ECG criteria are not specific for any of them. Atrial tachycardia with higher heart rate is possible and atrial flutter with lower heart rate is possible. Atrial flutter may have an isoelectric line between p waves because of atriotomy scars causing conduction block. More important is to identify mechanism of atrial tachycardia during electrophysiological study. Electrophysiological study gives us a better idea regarding mechanism of atrial tachycardia. Atrial tachycardia can be focal or macroreentrant. Focal can be because of automaticity, triggered activity or microreentrant cause. Coming to this case, Here, atrial

What is the diagnosis? Click the button below to view answer: Show Answer