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Cardiologia Siglo XXI

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Cardiologia Siglo XXI

Fair use is a use permitted by copyright statute. Consulta de Cardiologia Particular

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09/06/2026

Agitated Saline Contrast

09/06/2026

Agitated Saline Contrast

09/06/2026

Bicuspid Valve

04/06/2026

Keypoints regarding Intramural Hematoma (IMH):

1. It teaches you to suspect it. Not every "no-reflow" or loss of flow after is thrombus.

2. It reinforces that angiography is not enough. IMH is a disease of the wall, not just the lumen.

3. It shows that there is no single treatment. It can be conservative, stenting, cutting balloon, scoring balloon, DCB, prolonged balloon angioplasty, or surgery.

4. It distinguishes between mechanisms. IMH due to distal wire is not the same as IMH due to proximal guidewire or stent edge injury.

5. It is highly applicable to CHIP/calcified lesions. In lesions with calcification, high-pressure balloon angioplasty, atherectomy, and stent edge angioplasty, the risk of IMH increases.

31/05/2026

Patients with coronary aneurysm have been noted to have an overall high rate of ACS and mortality. In a registry of 51 555 coronary angiography cases, 414 patients had CA, out of which 82% NSTEMI. After a mean of 4 years of follow-up, 20.7% patients died and 42% had a cardiovascular event.

28/05/2026

Looking at the image reminds me of an echocardiography professor who told me to index by height in obese patients; although the article isn't about that, perhaps in the future finally the / will make it a standard.

28/05/2026

The modern strategy is not IVL vs. rotablator, but rather choosing based on calcium morphology and integrating intravascular imaging.

IVL is probably the best tool when the balloon crosses and the calcium is deep/circumferential or behind a stent; RA/OA remains better when the lesion is balloon-uncrossable or very long.

1. IVL modifies deep calcium, something that rotablator does not do.
2. If the IVL balloon does not cross, it is not the first tool: consider RA/OA for crossing.
3. In calcified bifurcations, IVL is attractive because it allows both branches to be protected with wire and reduces the risk of SB loss.
4. In stents underexpanded by calcium, IVL can deliver energy through the struts and fracture underlying calcium.
5.The lower incidence of no-reflow is a key advantage over mechanical ablation.

27/05/2026

Admit the patient, not the diagnosis.
Kilip I patients, successfully revascularized, without arrhythmias, hypotension, or AKI and with a low Zwolle ≤3 patients admitted to the ward have very low in-hospital mortality, 0–0.5%, and a low need for critical care therapies, 0–2.6%; do not necessarily require coronary care.
For stable NSTEMI patients, the incidence of in-hospital cardiac arrest is

23/05/2026

1. Baseline lactate defines initial shock severity, but lactate trajectory defines shock reversibility, response to therapy, and the need for escalation of circulatory support.
2.An 8-hour lactate ≥3.1 mmol/L after initial management is a major warning sign in AMI-related cardiogenic shock.
3.Epinephrine can increase lactate through aerobic glycolysis and may confound interpretation.
4.Peripheral venous lactate should not be used interchangeably with arterial lactate in shock.
5.Lactate >2 mmol/L supports Stages C–D, and lactate >8 mmol/L is associated with Stage E cardiogenic shock.

22/05/2026

DCB in Complex High Risk

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