Learning Cardiology

Background: We don't know the optimum mode of therapy for patients with stable ischemic heart disease along with moderate to severe myocardial ischemia on non-invasive stress testing. Routine early invasive therapy was compared with optimal medical therapy in this trial. Study design: Patients: Stable ischemic heart disease with moderate to severe ischemia on stress testing. All patients underwent CT coronary angiogram prior to inclusion in the trial to rule out significant LM disease. Exclusion: - LM stenosis >50% (on CT coronary angiogram) - Recent MI - LVEF < 35% - Unacceptable angina at baseline - NYHA class III and IV heart failure - Prior PCI or CABG within last one year Groups: Routine invasive therapy (n = 2588) vs initial optimal medical therapy (n= 2591) Interventions in both groups: - Routine invasive group: Patients underwent angiography followed by PCI or CABG as per the anatomy. - Medical therapy group: All patients were put on initial medi...

Q. Szabo technique is used for? A. PCI of ostial lesions B. PCI of SVG graft vessels C. PCI of CTO lesions D. PCI of distal left main stenosis Answer: A. PCI of ostial lesions Explanation:  Szabo technique-  Correct stent placement is very important for ostial lesions for optimal coverage of lesion.  Szabo technique first described in 2005, involves passage of two guidewires. First guidewire (primary) is placed in vessel to stented and 2nd guidewire (anchor) is placed in the lumen of side branch. 2nd guidewire is passed over most proximal strut of stent. Stent then travels over both guidewires, the movement of stent is stopped by anchor guidewire at the ostium of vessel to stented. Then the stent is deployed completely covering the ostial lesion. (Image source: drsvenkatesan.com)

Q. Which of the following is false about ORBITA trial:  A. Stable ischemic disease patients were included and were randomized either to PCI or sham procedure. B. Patients with multi-vessel disease were included whereas acute coronary syndrome patients were not included. C. PCI did not result in significant improvement in exercise time as compared to sham procedure. D. Diabetic patients were included. Answer:  B. Patients with  multi-vessel  disease were included whereas acute coronary syndrome patients were not included. Explanation:  ORBITA trial:  Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina Patients with stable angina and severe single-vessel stenosis were randomized in a 1:1 fashion to either PCI or a placebo sham procedure.   Coronary angiography was done via a radial or femoral arterial approach in all patients.  In all...

Q. Which of the following is incorrect regarding prevention of contrast induced nephropathy? A. Preprocedure hydration with 0.9% NaCl is better than 0.45% NaCl B. Low osmolar contrast media is better than iso-osmolar contrast media C. Preprocedure use of N-acetyl cysteine is not recommended D. Biplane angiography is useful in reducing the dose of contrast Answer: B. Low osmolar contrast media is better than iso-osmolar contrast media Explanation: Contrast induced nephropathy (CIN) Transient increase in creatinine by 0.5 mg/dl or 25% increase from baseline. Occurs in 5% of patients following cardiac angiography. It is non-oliguric, peak within 1 to 2 days and then return to baseline by 7 days but may rarely require chronic dialysis. Risk factors: DM Pre-existing renal dysfunction Multiple myeloma Volume depletion Other nephrotoxic drug therapy The recommended maximum dose of contrast to limit CIN is 3 ml/kg (or 5 ml/kg divided by S. creatin...

Q. Advantages of choosing left radial artery over right radial artery during trans-radial PCI are all except? A. Prevalence of subclavian artery tortuosity and radial artery loops are three times more common in right radial artery B. Hooking of LIMA is easier from left radial artery C. Learning curve is short in left radial route than right D. Incidence of radial artery spasms is more in right radial artery Answer: D. Incidence of radial artery spasms is more in right radial artery Explanation: PCI from left radial route has many advantages as compared to right artery. Prevalence of radial artery loops and subclavian artery tortuosity are more three times more common on right side. Learning curve is longer in right radial artery and hooking of left internal mammary artery (after CABG) is difficult from the right radial route because it involves crossing to the opposite side from the aortic arch. However, the incidence of radial artery spasms during the procedure is...