Stable CAD: Revascularization concepts + Diagnostic strategy- Elias Hanna
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- čas přidán 26. 07. 2024
- 0:00 Part 1: Revascularization rationale + the 4 major trials of medical therapy vs revascularization. Importance of total plaque burden vs stenosis. Importance of anatomic extent over ischemic severity.
Revascularization in LV dysfunction (CABG STICH) (26:27)
CABG vs PCI, 4 major trials (28:57)
30:50 Part 2: Diagnostic strategy. Growing role of coronary CTA over ischemic testing. Modern diagnostic algorithm.
52:03 Importance of CT calcium score testing in asymptomatic and even symptomatic patients.
Thanks greatly doc hanna! We got our whole cardiology squad (german Hospital in nordrhine westfalia) bingewatching your Videos. Their one of its kind
That is great to hear, thank you! And greetings to you and to your colleagues in Westfalia
thank you very much dear Dr Hanna.
Each of your videos is as valuable as several books.
waiting others, passionately.
Thank you Dr Hanna, for your wonderful and lucid lectures. You have a great talent for simplifying complex issues and teaching them in a practical manner. Keep up the good job!!
Thank you Dr.Hanna.You are a gifted teacher to all cardiology fellows .pls do more and more videos on multiple topics .We can understand and do a better quality work for the patients .
Amazing information Dr Hanna! Please don’t stop sharing your knowledge and expertise with these videos, you have an amazing reach. Keep up the wonderful work.
Amazing lecture.
This is an interesting take on current studies and recommendations on CAD. I am listening to and reading all I can on this subject. This vid contradicts many others.
My mate has been diagnosed with high risk 3-vessel disease with stress SPECT, CTA, cath. Has mild to moderate angina (II-III) but has cut his activity down probably half in past 2 years (small scale farmer/homesteader with lots of physical activity requirements) first do to fatigue then angina and dyspnea.
Findings: LAD bifurcation with D1, 80% proximal LAD and 100% mid LAD. Other 2 major vessels and OM are 30-50%. Only high cholesterol risk factor and 700 calcium score. Good weight and diet, never smoker or much alcohol.
He is being pushed to get CTO-PCI (by low-mid volume operator and hospital). Also talking to a surgeon about CABG (mate only willing if its MIDCAB).
He has anemia and GI changes and family history of colon cancer requiring upper lower endoscopy. But noone will do it with his heart as is.
Optimal medical therapy so far (30 days) not helping and maybe making things SEEM worse due to a lot of new onset fatigue (metropolol?).
If revascularization does not affect prognosis and only maybe helps symptoms and with the risk of procedural MACE, does he revascularize or just accept he cannot do extreme activity anymore (shoveling, lifting much weight, etc)?
This video makes me think sticking with meds is not unreasonable. Particularly since we have no access to strong performing CTO-PCI operators or facility, maybe none for MIDCAB either.
Can we convince GI doc to investigate a potential concerning cause for anemia without "fixing" his heart?
Anyone want to weigh in please do. Would appreciate any further ideas or video/blog/etc recommendations. Not getting great help from local rural facility.
Sir u r one of my all times Fav professor..Thank u so muuch
Thanx for laborious efforts
Great lecture
Extraordinary...
Thank u so much
Thanks a lot
great
Dear Dr Hanna, I have a question about the CABG benefit on non-LMCA diseases. The 4 trials showed that CABG reduced mortality but ISCHEMIA trial showed CABG only reduced the risk of MI in those disases. So which should we trust ?
dr hanna which is the (most)correct therapy?
A healthy 55yo man, smoker with LDL 100 has done CTTA for atypical cardiac symptoms. The exam shows 40% mid RCA and 40% distal LAD srenosis. Next step:
A.Lifestyle measures
B.atorvastatin 40/rosuvastatin 20
C.ator 40/rosu20 and aspirine
D. SPECT/STRESS ECHO
Good question. My answer is B. This patient is a primary prevention patient (no prior cardiac or vascular event, no obstructive CAD with angina), and I would apply primary prevention measures: statin, but not aspirin, as aspirin's primary prevention trials failed to show a survival benefit or net clinical benefit (eg, ASCEND, ARRIVE, and meta-analysis). He is at increased risk in light of the presence of coronary plaque burden, although calcium score (not provided) would provide a better idea about the prognosis of this patient. Lipid guidelines apply primary prevention measures to high calcium score without prior cardiovascular events or obstructive CAD with angina; but data from MESA trial (circulation 2021) suggest that very high calcium score >1000 has the same risk as secondary prevention patients.