Cardiology Learner : ECG, Echo & Clinical

23/05/2026

trial::
PROgnostic Value of Precision Medicine in Patients With Myocardial Infarction and Non-obStructive Coronary artEries.

Study population

Patients with suspected MINOCA:

Acute MI by Fourth Universal Definition

Coronary angiography: no stenosis >50%

No obvious alternative diagnosis explaining presentation

Trial design

randomized trial, comparing:

1) Stratified treatment arm

Advanced diagnostic workup to identify the actual MINOCA mechanism, then therapy tailored to the cause.

included:

OCT: plaque rupture/erosion, SCAD

Acetylcholine provocation test: epicardial or microvascular spasm

Cardiac MRI: confirm MI; exclude myocarditis/Takotsubo

TEE: search for embolic source

2) Standard of care arm

Mainly angiography-based routine care, with CMR recommended, and empirical ACS-style treatment: antiplatelet/statin ± beta-blocker/ACE inhibitor as indicated.

Etiology found in stratified arm

Advanced workup identified the mechanism in 80% of cases. Most common causes were:

Frequency

Epicardial spasm 35.6%
Atherosclerotic plaque instability 22.2%
SCAD 13.3%
Coronary embolism 4.4%
Microvascular spasm 4.4%
Undefined 20%

Initial suspected diagnosis was reclassified in 75.5% of stratified-arm cases.

according to cause

The key message is: treat the mechanism, not just the angiogram.

Mechanism Targeted treatment approach

Plaque instability DAPT ± PCI, statin
SCAD Antiplatelet ± PCI, beta-blocker
Epicardial/microvascular spasm Calcium channel blocker
Coronary embolism Anticoagulation
Undefined Standard ACS therapy

endpoint

Change in angina status at 12 months, measured by Seattle Angina Questionnaire Summary Score — SAQSS.

:

Outcome Stratified treatment Standard care p value

SAQ Summary Score improvement 12.3 ± 5.2 2.9 ± 9.5

11/05/2026

10/05/2026

Not all STE means heart attack.
Use your brain to discover something different.

10/05/2026

Updates from .

03/05/2026

.

22/02/2025

Moving clip PLAX
- Echofree zone in IVS
- Large VSD which is non-restrictive, malalinged due anterocephalad deviation of conal septum
-Less than 50% overriding of aorta from RV side
-Aorto-mitral continuty

All those features are very characteristic of Tetralogy oF fallots.

Other supportive echo images also given.

20/02/2025

HOCM
Hypertropic obstructive cardiomyopathy.

17/02/2025

Global Longitudinal Strain (GLS) is an echocardiographic parameter that measures the deformation of the left ventricle in the longitudinal direction. It's a more sensitive and earlier indicator of left ventricular systolic dysfunction compared to traditional measures like ejection fraction (EF).

Here are some key points about GLS:

1. Measurement: GLS is derived from speckle tracking echocardiography, which analyzes the movement of speckles (natural acoustic markers) in the myocardium during the cardiac cycle.
2. Clinical Importance: GLS can detect subtle changes in left ventricular function, making it useful for early diagnosis and monitoring of conditions like cardiotoxicity from chemotherapy, hypertension, diabetes, and obesity.
3. Normal Value: In adults, a GLS of less than -16% is considered abnormal, while a GLS of more than -18% is considered normal.
4. Applications: GLS is used in various clinical scenarios, including evaluating patients with hypertrophic cardiomyopathy, amyloidosis, aortic stenosis, and mitral regurgitation.

05/02/2025

Graft vessel CAG.

LIMA to LAD
Radial conduit to RCA

LAD graft usually taken fron LIMA.

RCA Graft usually from RIMA or Nondominant hand Radial artery or SVG.

Side branch of Grafts are occluded by pins.

Radil or SVG graft usually attached to Aorta.

04/02/2025

Acute pericarditis.

# thing , commonly forgotten.

When underlying etiology is there?
1. Fever >38 degree.
2. Imunocompromised.
3. Non responder to NSAID
4. Related trauma history
5. Use of anticoagulant.

When steroids should be used as furst line drug?
1. CTD- SLE
2. Anticoagulant users
3. TB effusion

# of auscultation

# Finding

Conventional therapy.

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