Cardiology (In Work)

Myocardial infarction catheterization video snaps (Patient ID nondisclosed)

    Mid right coronary wire passage prior stenting: wire insert and sprinter balloon dilation.

    Right coronary post-stenting.

   Left anterior descending artery after stent install 2-3 mm distal to previous stent.

   LAD showing partial occlusions in tertiary branches - first diagonal and septals.

Atherosclerosis Overview - Review Paper

Inflammation, Atherosclerosis, and Coronary Artery Disease†
Goran K. Hansson, M.D., Ph.D.
The New England Journal of Medicine352 (16):1685-1695
April 21, 2005

PPT slide set overview of coronary atherosclerosis by Hansson


Narrative additions to Hansson paper slides (notes inserted by T Mallow, MS-Biology)

Reference pictorials from other sources (various sources) relevant to Hansson paper

General myocardial infarction papers

LAD Stent Follow-Up and Sub-Endocardial Septal Wall Infarct

Stem cell therapy

Adult stem cell myocyte proliferation research and pending FDA trials
Bone marrow transplantation for the heart: fact or fiction?

Valve disorders

Porcine mitral valve replacement

Unusual cardiac anomalies

Left Ventricular Apical Pseudoaneurysm - Echocardiographic and Intraoperative Findings (Apical aneurysm treatment via bovine tissue)

Cardiac imaging

The Important Properties of Contrast Media: Focus on Viscosity

Bifurcation stenting

Simultaneous Kissing Stents (SKS) Technique for Treating Bifurcation Lesions in Medium-to-Large Size Coronary Arteries
Acute and Long-Term Results of Bifurcation Stenting
Simple and Complex Stent Strategies for Bifurcated Coronary Arterial Stenosis Involving the Side Branch Origin
Randomized Study to Evaluate Sirolimus-Eluting Stents Implanted at Coronary Bifurcation Lesions
Randomized Study on Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions: The Nordic Bifurcation Study

Cardiac enzyme activity

Predictive markers for emerging infarctions and other enzymatic reactions associated with aerobic and anaerobic reactions affiliated with cardiac function:

LDH - lactate dehydrogenase - this protein is affiliated with anaerobic respiration and is produced to allow for ATP production when cells are hypoxic (experience a loss in the delivery of blood in oxygenated hemoglobin. It is not used anymore as a marker of an infarction due to other enzymes which are more reliable as markers in infarction events. But the amounts of this enzyme in circulation can tell one how much relative anaerobic activity is going on in the presence of events that have lower aerobic pathways (such as a heart with lowered ejection fraction during and after an MI).
CRP - C-reactive protein - this is one of the most widely used markers of infarction events and values dramatically increase.
CPK - Creatine phosphokinase or creatine kinase - this is a common protein the body produces in many pathways involving energy utilization. High levels can result from physical exertion, muscle trauma, as well as anomalies including delirium and convulsions. When a myocardial infarction occurs, heart muscle has been traumatized. Hence the synthesis of this protein post-MI, and it is known that this enzyme is produced in large amounts during 90% of infarctions. There are three isoforms:
    Creatine phosphokinase isoenzymes - The genes for these subunits are located on different chromosomes: B on 14q32 and M on 19q13.
        CK-MB -  produced in heart muscle
        CK-MM - produced in skeletal muscle
        CK-BB - produced in brain tissue
Troponin T and I - Cardiac troponin T and troponin I are the most specific and sensitive laboratory markers of myocardial cell injury and therefore have replaced creatine kinase MB as the gold standard. Reference: Christian W. Hamm, MD; Evangelos Giannitsis, MD; Hugo A. Katus, MD. Cardiac Troponin Elevations in Patients Without Acute Coronary Syndrome. 2002. Circulation.106:2871. (From the Kerckhoff Heart Center (C.W.H.), Bad Nauheim, Germany, and the Department of Cardiology (E.G, H.A.K.), University of Heidelberg, Heidelberg, Germany. )
Myoglobin

Clotting factors and markers

PT - Prothrombin time - time it takes for prothrombin to convert to thrombin in the coagulation cascade. The longer the PT time, the longer it takes for blood to clot
INR - International normalized ratio
The physiology of vitamin K nutriture and vitamin K-dependent protein function in atherosclerosis

Clotting pathway inhibitors

Plavix (Clopidogrel) - inhibits binding of ADP to surface of platelets; platelets henceforth can not activate to aggregate at a potential thrombus site
Aspirin - cycloxygenase inhibitor, reduction of TXA2 production
Coumadin (Warfarin) - inhibitor of g-carboxylation reactions required for activity of thrombin, factor VII, IX, and X; and C and S proteins

Heparin
EDTA chelation
Glycoprotein IIb/IIIa inhibitors

Heme and heme protiens, myoglobin (muscle) and hemoglobin (blood)

Hyperlipidemia, Hypercholesterolemia, Lipidemiology and lipid profiles

Cholesterol
LDL
HDL
Triglycerides

Pathways that participate in vascular diseases related to lipid chemistries

Electrophysiology and cardiac conduction

in work

Cardiac arrest, fibrillation disorders

in work

MRI Imaging

Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning

Movie loops - see text in above link on cardiomyopathy for details. These movies will loop indefinitely until you click on the browser X button.

Left ventricular end systolic cardiac MRI.

(A) Top movie: Acute phase with akinetic apical and mid-left ventricular wall and reduced or absent wall thickening (a cardiac MRI movie demonstrating the acute phase is provided as Supplementary Movie 1 online). (B) Bottom movie: Follow-up image at 5 months, demonstrating normal left ventricular systolic function, with recovery of motion and wall thickening in all segments (a movie recorded during follow-up is provided as Supplementary Movie 2 online).

Citation:

Lyon, Alexander R, Paul SC Rees, Sanjay Prasad, Philip A Poole-Wilson and Sian E Harding. 2007. Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nature Clinical Practice Cardiovascular Medicine January 2008 5(1).

Fluoroscopy and Cardiac Catheterization Imaging

Relevant terminology

Angina pectoris (chest pains) is pain felt beneath the sternum or in the precordial area. The hypoxic pains are typically provoked by exercise or cold and submitted by subendocardially situated nerve fibres. The pains are relieved rapidly by nitro-glycerine and rest.

Arteriosclerosis refers to atherosclerosis (and further changes) of the peripheral arteries. 

Atherosclerosis is a process of progressive lipid accumulation (atheromatosis) and calcification of the inner arterial walls in the abdominal aorta, lower extremities and the arteries of the heart, brain and kidneys.

Bathmotropic state refers to the irritability of the myocardium. 

Cardiac insufficiency is a disorder, where the heart cannot pump enough blood to satisfy the nutritive needs of the body.

Central venous pressure (CVP) is the pressure measured in the caval veins at the level of the heart or in the right atrium.

Chronotropic state refers to the cardiac frequency. 

Compliance of the resting cardiac chambers refers to dV/dP (chamber compliance)  - the reverse of the elastance (dP/dV) of relaxed tissue.

Cardiac contractility is the dP/dV of the contracting ventricle. The contractility is depicted on the pressure-volume loop of the cardiac ventricle. Contractility refers to the change in slope of the pressure and volume increase from isovolumetric rest to contraction. Contractility is a function of contraction by crossbridge cycling.

Diagonal is the nomenclature referring to an artery that routes at an acute angle with its parent artery.

Ejection fraction refers to the stroke volume of blood as a fraction of the end-diastolic ventricular volume. This is a useful index of contractility.

Inotropic state is another term for the myocardial contractility. 

Intermittent claudication refers to chronic ischaemia of the legs with hypoxic pains while walking.

Dromotropic state refers to the conduction velocity of the myocardial conduction system. 

Maximum oxygen uptake is the oxygen uptake during maximum exercise. This is a measure of endurance capacity, and when expressed per kg of body weight it is also called the fitness number (ml min-1 kg-1). 

Mean circulatory equilibration pressure (MCEP) is the filling pressure everywhere in the circulatory system following cardiac arrest. 

Osteal

Ostium is an opening; in cardiology, the arterial lumen.

Percutaneous intervention (PCI) is a technique using a device that is entered with breaking the skin for access, such as a heart catheter.

Pericardium is the tissue surrounding the heart.

Shelves

Sub-endocardial wall

Venous pump refers to all local external forces acting on valvular veins and facilitating venous return.

Venous return is the bloodflow reaching the right atrium (in steady state a similar bloodflow reaches the left atrium).

Ventricular stroke work is the work applied to the blood at each ejection from the ventricle.

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