Learning Cardiology

The patient contacts the doctor over phone with this report.   Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine.  Should he be worried about this and come to emergency department as soon as possible? Correct answer-  ECG machine has calculated his heart rate incorrectly.  Heart rate is around 100 beats per minute.  Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods.    Now, should he come to emergency department? Not because of detection of high heart rate.  But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist. 

Radial artery access Anatomy The radial artery is branch of brachial artery below the elbow and runs on the lateral aspect of forearm to the wrist.  At the level of wrist, it lies on the top of styloid process of radius bone and the scaphoid bone.  The artery joins the deep communicating branch of ulnar artery to form deep palmer arch.  Advantages of radial access over femoral access: The bleeding complications are uncommon with radial artery puncture as it can be easily compressed.  Prolonged bed rest is not required.   It can be helpful in cases with difficult femoral access such as morbid obesity and peripheral vascular disease.  The hand has collateral flow from the ulnar artery via palmer arch.  Patient can be mobilised soon after the procedure.  Left radial access is preferred compared to right radial access for cannulation of left internal mammary artery (LIMA) to left anterior descending (LAD) graft post coronary artery bypass surgery. Allen's test Before taking radial arte

  SGLT2 Inhibitors First developed for glycemic control for patients with diabetes, have become one of the four pillars of guideline-directed medical therapy for patients with HF  In 2015, the EMPA-REG OUTCOME study evaluated the impact of empagliflozin on major adverse cardiac events in patients with diabetes and unexpectedly showed a 35% relative risk reduction in hospitalization for HF.   How Do SGLT2 Inhibitors Work?  SGLT2 inhibitors block the reabsorption of sodium in the proximal tubules of the kidney.  Significant natriuresis as well as osmotic diuresis due to glucosuria.  Have also been shown to attenuate adverse cardiac remodeling and fibrosis in animal models. Available drugs Empagliflozin: SGLT 2 inhibitor, Dose 10 mg and 25 mg Dapagliflozin: SGLT2 inhibitor, Dose 5 mg and 10 mg Sotagliflozin: SGLT 1 and 2 inhibitor, Dose 200 mg and 400 mg Sotagliflozin is slightly different than dapagliflozin and empagliflozin in that it is a combined SGLT1/2 inhibitor.  SGLT2 inhibition l

 

Points to remember about pulmonary artery hypertension 1. Pulmonary arterial hypertension (PAH) - mean pulmonary arterial pressure > 20 mm Hg and a pulmonary vascular resistance > 3 WU, with a normal capillary wedge pressure of < 15 mm Hg 2. Increased pulmonary resistance results in right ventricular overload and right heart failure 3. Mortality of at least 50% in 7 years 4. Pregnancy in women with PAH is associated with high maternal and neonatal mortality rates 5. The only therapy with a direct survival benefit is intravenous epoprostenol, a prostanoid vasodilator 6. A positive acute vasodilator response is defined by a decrease in mean PAP ≥ 10 mm Hg to reach a mean PAP < 40 mm Hg with an improved or stable cardiac output. In these patients, high-dose calcium channel blockers significantly lower PAP and vascular resistance. 7. Most common cause of death- right sided heart failure 8. Agents within the same class (including PDE-5 inhibitors and guanylate cyclase stimulat