SpR GIM Training Day
Sort of experimental one, this, especially since I sent it from my iPhone. It turns out I'm trying to do several different things with this blog (but then it is my blog). I think that's ok since I can use posts such as this both as my personal reflection, and as examples of different ways to use a blog. Anyway, today was regional GIM SpR teaching on cardiology. Over all, lots of knowledge and expertise but most speakers too keen to show that rather than educate effectively. Take home messages required some distillation...
AF - Ablation? main indication is symptoms (and drug failure). Amiodarone little use for rate control, for rhythm control ok but poisonous.
Cardiac MR - Cost in Manchester only 3x echo. ?Now should be 1st line for myocardial perfusion.
Interventions for LVF:
Medical Rx
Beta blockers most important, some data that early (acute) beta blockade is lifesaving. (observational data). Optimal rx may soon include adding ivabradine to B-blocker.
Biventric pacing (resync) for NYHA 3 or 4 despite medical mx, EF <35% + LBBB
ICDs for 2ndary prevention, primary prevention post-MI, CCF, VT on tape and stimulation.
VADs = mini bypass machines. Weak evidence base. Big stroke risk.
Used for:
1. Buy time before transplant (4-6/52)
2. Bridge to recovery (longer)
3. Long term (not on NHS) if not fit for transplant.
Transplant for the otherwise fit. 20% mortality at 1yr.
Aortic Stenosis: once symptomatic, survival is months and QoL poor.
Transcutaneous AV replacement:
For severe symptomatic AS with excessive surgical risk + survival > 1yr. No good survival data yet.
AF - Ablation? main indication is symptoms (and drug failure). Amiodarone little use for rate control, for rhythm control ok but poisonous.
Cardiac MR - Cost in Manchester only 3x echo. ?Now should be 1st line for myocardial perfusion.
Interventions for LVF:
Medical Rx
Beta blockers most important, some data that early (acute) beta blockade is lifesaving. (observational data). Optimal rx may soon include adding ivabradine to B-blocker.
Biventric pacing (resync) for NYHA 3 or 4 despite medical mx, EF <35% + LBBB
ICDs for 2ndary prevention, primary prevention post-MI, CCF, VT on tape and stimulation.
VADs = mini bypass machines. Weak evidence base. Big stroke risk.
Used for:
1. Buy time before transplant (4-6/52)
2. Bridge to recovery (longer)
3. Long term (not on NHS) if not fit for transplant.
Transplant for the otherwise fit. 20% mortality at 1yr.
Aortic Stenosis: once symptomatic, survival is months and QoL poor.
Transcutaneous AV replacement:
For severe symptomatic AS with excessive surgical risk + survival > 1yr. No good survival data yet.
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