Who is an “Interventional cardiologist” ?

Is he a person who puts a metal coil coated with a synthetic fungus in a incidentally detected block inside a small coronary artery and sends the bill to the Insurance company ?

Is he a person in a cosmopolitan hospital who opens up a chronically closed coronary artery , in an asymptomatic patient and live telecasts his achievement trans continentally ?

Is he a person who checks in by the early morning flight and puts multiple wires in an aged patient with class 3 heart failure and make him walk 20 meters extra at a cost of 1000$ / Meter ?

Is he a person living in Wall street , who looks for variety of holes In the heart and trying to occlude it with exotic devicespci ptca stent

Is he the unknown physician who Intervenes in the natural history of Rheumatic heart disease and arrests immune mediated valve damage by giving the monthly injections penicillin in remote parts of our country ?

Is he the person who Intervenes to prevent young persons from smoking and help maintain their coronary endothelium enriched with nitric oxide & arrest the coronary epidemic ?

cardiologist 2

Is he the small town doctor who Intervenes to treat a breathless cardiac failure patient with digoxin and frusemide and dramatically alleviate the symptoms and prolong the life of our poor country men?

Is she the village health nurse from an inaccessible health centre located in a hilly terrain , Intervening successfully, by pulling out live babies from severely anemic pregnant mothers with failing hearts ?

pci ptca cardiologist coronary angiograms

What is up sloping ST depression ? How do you measure it ? What is the clinical significance ?

What is up sloping ST depression ? How do you measure it ? What is the clinical significance ?


ST segment depression is the classical response to stress during excercise stress testing. (EST)Not all types of ST segment are pathological.The ST segment should depress atleast 1 mm below the isoelectric segment and it should be depressed for 80msec from the J point.

It must satisfy two criteria .

1. The quantum of ST depression should be > 1mm at 80msec from J point.
2. Slope of ST segment

Always pathological slopes

* Horizontal
* Down sloping

Most often pathological

* Slow up sloping

Non pathological slope

* Rapid up sloping with ST depression
* Rapid Up sloping depression of only the J point( The classical normal physiological response to excercise )

Horizontal or down sloping ST segment is easily recognised .When there is junctional ST depression with a ST segment that is climbing upwards , it is some times difficult to interpret.

How do you measure the slope of ST segment ?

We don’t have the trouble of measuring it as the computer does this job automatically. But a cardiology fellow need to know how it is measured !


slow upsloping st depression st segment ecg

A slow upsloping ST segment( <1.5mv.sec )can be a significant marker of ischemia.This is especially true in established CAD or individuals at high risk . For so slow up sloping a .5mm allowance is given to filter out false positive (ie to improve sensitivity) . So for slow up sloping ST segment , to be reported as positive it should depress atleast 1.5mm or some times 2mm.

upsloping st segment tmt rapid upslope slow upslope

Available evidence suggest a rapidly upsloping ST segment (> 1.5mv /Sec) is a non ischemic response irrespective of the quantum of ST depression at 80msec. However , a rapidly upsloping ST is rarely depressed beyond 2mm .( This is because , the geometric hyperbolic curve of ST segment does not allow a situation of 3mm ST depression at 80msec with rapid upsloping )

What is the angiographic correlation of slow upsloping ST segment depression?

Few studies are availbale to address the issue. It is believed slow up sloping of ST depression is often associated with CAD but it is very rare to find a critical and proximally located CAD.Left main disease is almost never manifest with slow upsloping ST depression.

What is the significance of slow upsloping ST in clinical situations like unstable angina ?

It is rare for cardiologist to diagnose or “even look for” slow or rapid up sloping ECGs in coronary care units. But , a patient with stable CAD , sinus tachycardia , angina can exactly mimic a stress test situation .

Some of the low risk UA , mainly secondary UA due to increase demand situations manifest with slow upsloping ST depression , while classical thrombotic occlusions produce the typical horizontal or downsloping ST segment depression.

Valuable CCU Calculators & IV Medication Guidelines

Here is an online website to solve our problems faced in CCU regarding critical calculations

EKG Calipers

Find more photos like this on CardiologyRounds.com

Atrial Fibrillation & Heart Failure New Advances

Here is a link

Cardiology Links

http://www.cardiologyonline.com/organizations.htm

http://www.escardio.org/membership/Fellowship/Pages/why-become-fellow.aspx?hit=QuickAction

http://www.escardio.org/membership/affiliated-societies/Pages/membership.aspx

http://my.americanheart.org/portal/professional/memberservices

http://www.scai.org/drlt1.aspx?PAGE_ID=132

http://www.allbusiness.com/health-care/medical-practice-cardiology/10550996-1.html

http://www.interventionalcardiologistsinstitute.com/

http://www.tkd.org.tr/english.asp?pg=357

Books in Cardiology