Sultania Cardiovascular Sciences

29/08/2025

How to treat Hypertriglyceridemia;(very important)...

Check TG Levels & categorise .

Group 1..Mild -Moderate (150-499mg/dl)
Group 2..Severe (_>500mg/dl

For Group 1 .(150-499mg/dl)

Goal is to just reduce risk of ASCVD ,not to reduce numbers

Step 1..Identify reversible causes & treat
Step 2..If age is >40years then calculate ASCVD risk ,if risk >7.5,then start Statins .if risk >7.5 & also other high risk features then start Statins +icosapent ethyl (2 × 2 g/day) (Class IIa)

Group 2..If LDL >_500mg /dl

Goal is to reduce ASCVD & 2nd goal is to reduce numbers below 500mg/dl to reduce risk of pancreatitis

•Now we have 2 Goals
Goal 1..To reduce risk of ASCVD
Goal 2..To reduce risk of pancreatitis

Step 1..Identify reversible causes & treat
Step 2..Calculate ASCVD risk if age is above 40 & start Statins first ,if pt has other risk factors too ,then give statins +icosapent ethyl (2 × 2 g/day)
Step 3..Add further drugs to reduce risk of pancreatitis to keep TGs level below 500mg/dl.
Recommended further drug is Volanesorsen 300mg/week(Class IIa) by ESC.....
Note ..Fibrates have little use ,almost out in recent ESC & also not how we prescribe it mostly.

14/08/2025

Technical Tips for DCB use ;

1. Minimize Coating Loss: Avoid contact between the DCB and blood, contrast, or guide catheter walls prior to inflation. Gentle handling and smooth navigation through the vasculature are essential.

2. Minimize Transit Time: Deliver the DCB to the lesion promptly (ideally 60 seconds) offers minimal additional benefit and may increase ischemia risk. Avoid high pressures (>16 atm) unless necessary, as they can damage the coating or vessel.

4. Positioning Accuracy: Utilize radiopaque markers on the DCB to align the drug-coated portion precisely with the lesion under fluoroscopy. Misalignment can result in untreated segments or drug delivery to healthy tissue (adverse remodeling).

15/06/2025

SVG degenation score

14/06/2025

Fontain ECG & Epsilon wave..(Post excitation waves)
....
•Seen at end of QRS to start of T waves
•Diagnostic of ARVD ,it is one of Major criteria
( its opposite is Delta wave occurs at start of QRS, diagnostic of wpw)
•Sensitivity is low below 30%
•Most prominent in right precordial leads
•Best seen in the ST segment of V1 and V2.
•Discovered by Fontaine so also k/as Fontain waves.
•Fontain ECG leads enhance Epsilon waves

Method to do Fontain ECG

▪︎RA electrode is placed at Manubrium
▪︎LA electrode is placed is Xiphoid
▪︎L-Foot electrode placed at V4 site
▪︎Recording is done at 20mm/mv & 50mm/sec
▪︎Recording in lead I, II ,III in ECG after shifting the electrodes produces the corresponding Fontaine leads FI,FII,FIII
•F1 is more sensitive to look for epsilon waves.
Sensitivity is increased from 30% to 66%.....
Other uses of Fontain leads .
•To look for AV dissociation
•To look for atrial rhythms

13/06/2025

Classification & Mechanism of SVG Failure

1.Early Graft Failure .0-30Days ( Thrombosis)
2.Mid term Failure 30D-1Year (Intimal Hyperplasia)
3.Late Onset >1year (Atheroscelosis )

13/06/2025

SVG Occlusion Rate

▪︎Before Discharge ....2-4% are occluded
▪︎First Month ............ 10%
▪︎First year ................20%
▪︎First 5 years.............30% (@2%per year )
▪︎First 10 years...........50% (@4% per year)

12/06/2025

Differential of Irregular,Narrow Complex Tachycardia....

1.A.Fib
2.A.Flutter with variable block
3.MAT (Multiform atrial tachycardia)
4.Sinus Tachycardia with frequent APCs....
Below is ECG of MAT
Most common cause is Acute exacerbation of COPD

12/06/2025

of information about just from ECG

Question.
Diagnosis
Answer .Ventricular Bigeminy .
Question.
What may be heart structure
Answer .
Most probably it is Normal based on Inferior Axis in inferior leads (Upward complexes in inferior lead) which shows outflow based which are usually benign)
.
Question .

What is origin .
Answer .
Based on V1 ,RBBB morphology ,so it shows LV origin.
Question .
What information you can get from Shapes of VPCs.
Answer .
These are Monomorphic ,some shapes are different most probanly these are fusion beats ,as all VPCs have same axis ,not alternating so looks good prognosis ..
Question .
What information you can get from Coupling interval regarding Mechanism.
Answer.
Fixed coupling ..Mechanism may be Re entry or triggered
(For variable interval ,mechanism is automaticity)
As it shows Fixed coupling interval ,these have good prognosis ,in case of variable interval those are high risk.

Note .You can get other additional information based on time duration of Coupling interval regarding its prognosis ,these may be Short ,intermediate & long...

30/05/2025

https://youtu.be/-UBybSBQuWo?si=BLmpyVKO3OIhRk2G

🎬TCTAP 2025 Wrap-up Video from Social Media Ambassadors Dr. Muhammad Shuaib Abid joined virtually, experiencing live-streaming sessions packed wi...

30/05/2025

What is important finding ?