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STEMI with shock ,now pain better but on inotropes.. EF 20% Plan ? 1.Wait for stabilization & ONLY CABG 2.IABP +LAD PCI & staged later 3.IABP + RCA CTO & LAD PCI same sitting #CardioTwitter Mamas A. Mamas Hany Ragy MIЯVΛƬ #IC ༄ ｡° Dr Imran Hanif Hashmi akbar... show more

Abad khan,MD/DM

2,251 subscribers

22,506 Aufrufe • vor 3 Jahren •via X (Twitter)

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9 Kommentare

Profilbild von MIЯVΛƬ #IC

MIЯVΛƬ #ICvor 3 Jahren

Shocked patients generally don’t do well w a wait n watch strategy A minority of STEMI/CS undergo CABG in view of a persistently high operative risks & death rate (figure) MCS & PCI is a more widely available option & this is a comprehensive review of the topic ⤵️ @HenrytTimothy @SVRaoMD @thiele_holger @HollandTamis et al

Profilbild von Abad khan,MD/DM

Abad khan,MD/DMvor 3 Jahren

@mmamas1973 @Hragy @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 Amazing

Profilbild von Khalid Minhas, MD FACC

Khalid Minhas, MD FACCvor 3 Jahren

@mmamas1973 @Hragy @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 In STEMI and shock the best chance we have is to open the culprit vessel STAT and use LV support as needed/available

Profilbild von Abad khan,MD/DM

Abad khan,MD/DMvor 3 Jahren

@mmamas1973 @Hragy @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 Homogeneous answers across I.C community in CHIP cases what we/i do keeps me/us aligned & path correction if and Whenever wrong decision is taken .. IABP , LAD DES post dilated with 4.0 ..better now

Profilbild von Rakan I. Nazer راكان بن ابراهيم ناظر

Rakan I. Nazer راكان بن ابراهيم ناظرvor 3 Jahren

@mmamas1973 @Hragy @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 Not great targets for CABG except LAD and possibly OM. Generally early CABG if the presentation is within 6hrs from the onset of symptoms. Otherwise better to temper with IABP and have a discussion with the heart team.

Profilbild von John A. Fry MD, FACC, FSCAI

John A. Fry MD, FACC, FSCAIvor 3 Jahren

@mmamas1973 @Hragy @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 Fix LAD. Mechanical support (Impella preferred if available). Pulmonary catheter. Staged PCI of Cx.

Profilbild von Hany Ragy

Hany Ragyvor 3 Jahren

@mmamas1973 @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 Important question, why is the LVEF 20%? The anatomy here doesn’t explain that. Can u please put the ECG, what kind of STEMI?

Profilbild von Abad khan,MD/DM

Abad khan,MD/DMvor 3 Jahren

@mmamas1973 @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 RCA -100% LARGE LCX-OM 100% LAD was probably 100% too , got some TIMI-2 flow due to loading doses of antiplatelets + I.V heparin and I.V Bolus GP2b3a he received likely before he entered CATH LAB ( significant GRADE 4 residual thrombus still..(poor film today) 1st ECG @ midnight

Profilbild von Dr. A. Murshid الدكتور/ عبدالإله عبدالرحمن مرشد

Dr. A. Murshid الدكتور/ عبدالإله عبدالرحمن مرشدvor 3 Jahren

@mmamas1973 @Hragy @mirvatalasnag @DrIHHashmi1 @akbarul @Obisht @DrAnkushG @cardiodoc1988 No CABG, Cuz, risky& not yielding &won't tolerate X-clamp without devices ,nor manipulation of off pump.Not to mention poor recovery from Sx w' preop EF 20%&CHf require inotrop,I doubt you w' improve survival rather quality of life. I vote for :2.IABP +LAD PCI & staged later

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Ok imaging experts, what complication occurred during this Pci and what was done?will share angio/ptca shots later Ankur Phatarpekar Ankush Gupta Sreekanth Shetty #CardioTwitter Abad khan,MD/DM Mamas A. Mamas R Dr KK Dr Imran Hanif Hashmi Dr . $@ndeep K@m@t European Society of Cardiology American College of Cardiology European Society of Cardiology Journals

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#CardioTwitter How will u manage this complication? OCT 👇Abad khan,MD/DM Lorenzo Azzalini Evandro Martins F. MD Dr Sarita Rao Mamas A. Mamas MIЯVΛƬ #IC ༄ ｡° Rajesh VIJAYVERGIYA Angioplasty.Org Salvatore Brugaletta Sripal Bangalore Darshan Doshi, MD, MS abhishow..... Shariq Shamim Goran Stankovic, MD, PhD

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Ankush Gupta

104,840 Aufrufe • vor 3 Jahren

Contrast modulation is also helpful for microchannel tracking RCA & LAD CTO. RCA has a microchannel but wasn't able to cross with multiple wires. Did Contrast modulation then it was crossed easily with PJ wire without tip bend. LAD was crossed with Gaia 3rd. Timi III flow.

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55,016 Aufrufe • vor 3 Jahren

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