2026-04-28_10_39_27
May 14, 2026 19:05
· 56:32
· English
· Whisper Turbo
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Speaker 1 (2026-04-28_10_39_27)
Last part of the day,
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Speaker 1 (2026-04-28_10_39_27)
I should say you something about coronary artery
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Speaker 1 (2026-04-28_10_39_27)
disease, about chronic forms.
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Speaker 1 (2026-04-28_10_39_27)
Coronary artery disease or atherosclerosis could
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Speaker 1 (2026-04-28_10_39_27)
be said as a leading form of the death.
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Speaker 1 (2026-04-28_10_39_27)
These are data which are 30 years old.
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Speaker 1 (2026-04-28_10_39_27)
Ischemic heart disease together with cerebral vascular disease based on atherosclerosis
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Speaker 1 (2026-04-28_10_39_27)
killed more people than gastrointestinal infections,
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Speaker 1 (2026-04-28_10_39_27)
scar accidents and tumors.
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Speaker 1 (2026-04-28_10_39_27)
It is,
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Speaker 1 (2026-04-28_10_39_27)
but it's still,
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Speaker 1 (2026-04-28_10_39_27)
nowadays,
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Speaker 1 (2026-04-28_10_39_27)
almost each third patient will die from heart
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Speaker 1 (2026-04-28_10_39_27)
disease.
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Speaker 1 (2026-04-28_10_39_27)
Not only heart attacks,
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Speaker 1 (2026-04-28_10_39_27)
but strokes as well.
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Speaker 1 (2026-04-28_10_39_27)
In Czech Republic,
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Speaker 1 (2026-04-28_10_39_27)
it is almost the same.
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Speaker 1 (2026-04-28_10_39_27)
So this is the last,
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Speaker 1 (2026-04-28_10_39_27)
let's say,
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Speaker 1 (2026-04-28_10_39_27)
20 years.
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Speaker 1 (2026-04-28_10_39_27)
The heart
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Speaker 1 (2026-04-28_10_39_27)
problems slightly increase,
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Speaker 1 (2026-04-28_10_39_27)
but it's all something like about 30%.
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Speaker 1 (2026-04-28_10_39_27)
What is good is that the cerebral vascular disease based on
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Speaker 1 (2026-04-28_10_39_27)
atherosclerosis is going down.
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Speaker 1 (2026-04-28_10_39_27)
So together they killed something like 40 % people.
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Speaker 1 (2026-04-28_10_39_27)
What is very,
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Speaker 1 (2026-04-28_10_39_27)
very good is lowering of the number of the deaths.
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Speaker 1 (2026-04-28_10_39_27)
50 years ago,
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Speaker 1 (2026-04-28_10_39_27)
the coronary artery disease killed 800
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Speaker 1 (2026-04-28_10_39_27)
people from 1 million in men and something like 560
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Speaker 1 (2026-04-28_10_39_27)
women per 1 million.
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Speaker 1 (2026-04-28_10_39_27)
These numbers...
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Speaker 1 (2026-04-28_10_39_27)
are from the 80s decreasing very very
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Speaker 1 (2026-04-28_10_39_27)
rapidly.
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Speaker 1 (2026-04-28_10_39_27)
In the chronic coronary artery disease
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Speaker 1 (2026-04-28_10_39_27)
we speak or the basic is imbalance between oxygen
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Speaker 1 (2026-04-28_10_39_27)
supply and oxygen demand.
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Speaker 1 (2026-04-28_10_39_27)
On the supply side you have heart rate contractility and systolic
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Speaker 1 (2026-04-28_10_39_27)
wall stress.
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Speaker 1 (2026-04-28_10_39_27)
On the demand side you have vascular resistance and
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Speaker 1 (2026-04-28_10_39_27)
coronary blood flow.
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Speaker 1 (2026-04-28_10_39_27)
This is a picture how we image the
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Speaker 1 (2026-04-28_10_39_27)
atherosclerosis.
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Speaker 1 (2026-04-28_10_39_27)
We will find it in each presentation,
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Speaker 1 (2026-04-28_10_39_27)
so here as well.
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Speaker 1 (2026-04-28_10_39_27)
The endothelial dysfunction starts something like
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Speaker 1 (2026-04-28_10_39_27)
first decade,
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Speaker 1 (2026-04-28_10_39_27)
so in the 20 years.
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Speaker 1 (2026-04-28_10_39_27)
You are here.
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Speaker 1 (2026-04-28_10_39_27)
You have some intermediate vision.
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Speaker 1 (2026-04-28_10_39_27)
I am 50 years old.
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Speaker 1 (2026-04-28_10_39_27)
I am quite sure that I have some fibrous plaque in my arteries.
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Speaker 1 (2026-04-28_10_39_27)
To 50%,
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Speaker 1 (2026-04-28_10_39_27)
we don't care.
3:39
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Speaker 1 (2026-04-28_10_39_27)
You usually don't know about it.
3:42
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Speaker 1 (2026-04-28_10_39_27)
50 to 70 is something like cutoff.
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Speaker 1 (2026-04-28_10_39_27)
And from the 70%,
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Speaker 1 (2026-04-28_10_39_27)
usually it causes some problems.
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Speaker 1 (2026-04-28_10_39_27)
So today we speak about stable disease.
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Speaker 1 (2026-04-28_10_39_27)
So stable fibrous plaque for you.
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Speaker 1 (2026-04-28_10_39_27)
We will go through the history of the patient,
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Speaker 1 (2026-04-28_10_39_27)
through the physical examination.
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Speaker 1 (2026-04-28_10_39_27)
We will speak something about clinical
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Speaker 1 (2026-04-28_10_39_27)
tests and the idea is to set the risk of the coronary disease from
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Speaker 1 (2026-04-28_10_39_27)
low to the high.
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Speaker 1 (2026-04-28_10_39_27)
Estimation of probability can be based
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Speaker 1 (2026-04-28_10_39_27)
just on the basic predictors,
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Speaker 1 (2026-04-28_10_39_27)
which is age,
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Speaker 1 (2026-04-28_10_39_27)
gender, pain type.
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Speaker 1 (2026-04-28_10_39_27)
Other predictors,
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Speaker 1 (2026-04-28_10_39_27)
smoking,
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Speaker 1 (2026-04-28_10_39_27)
Q -wave changes,
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Speaker 1 (2026-04-28_10_39_27)
hyperlipidemia on diabetes.
4:26
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Speaker 1 (2026-04-28_10_39_27)
It's something like each
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Speaker 1 (2026-04-28_10_39_27)
day you will find such patients with these
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Speaker 1 (2026-04-28_10_39_27)
predictors,
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Speaker 1 (2026-04-28_10_39_27)
which leads to coronary artery disease.
4:41
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Speaker 1 (2026-04-28_10_39_27)
If you,
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Speaker 1 (2026-04-28_10_39_27)
let's say,
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Speaker 1 (2026-04-28_10_39_27)
you will have...
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Speaker 1 (2026-04-28_10_39_27)
A 70 -year -old man with typical angina and five risk
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Speaker 1 (2026-04-28_10_39_27)
factors.
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Speaker 1 (2026-04-28_10_39_27)
You can guess how probable is significant coronary
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Speaker 1 (2026-04-28_10_39_27)
artery disease for him.
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Speaker 1 (2026-04-28_10_39_27)
We will expect high.
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Speaker 1 (2026-04-28_10_39_27)
Not 90,
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Speaker 1 (2026-04-28_10_39_27)
something like 50%.
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Speaker 2 (2026-04-28_10_39_27)
So,
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Speaker 1 (2026-04-28_10_39_27)
each second has significant coronary artery disease.
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Speaker 1 (2026-04-28_10_39_27)
And opposite.
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Speaker 1 (2026-04-28_10_39_27)
If you will see young woman with
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Speaker 1 (2026-04-28_10_39_27)
atypical chest pain,
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Speaker 1 (2026-04-28_10_39_27)
the probability of coronary disease for such woman is very
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Speaker 1 (2026-04-28_10_39_27)
low. You will expect a long number.
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Speaker 1 (2026-04-28_10_39_27)
Guess something.
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Speaker 1 (2026-04-28_10_39_27)
Does somebody give less than five?
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Speaker 1 (2026-04-28_10_39_27)
Two.
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Speaker 1 (2026-04-28_10_39_27)
Okay, something like one.
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Speaker 2 (2026-04-28_10_39_27)
So...
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Speaker 1 (2026-04-28_10_39_27)
But if you will see 200 of such women,
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Speaker 1 (2026-04-28_10_39_27)
so you can assume that two of them have significant
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Speaker 1 (2026-04-28_10_39_27)
coronary artery disease.
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Speaker 1 (2026-04-28_10_39_27)
So it's very uncommon,
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Speaker 1 (2026-04-28_10_39_27)
but it could be.
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Speaker 1 (2026-04-28_10_39_27)
So if you see such couple,
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Speaker 1 (2026-04-28_10_39_27)
the woman of the right,
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Speaker 1 (2026-04-28_10_39_27)
from your point,
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Speaker 1 (2026-04-28_10_39_27)
is better on it.
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Speaker 1 (2026-04-28_10_39_27)
Risk factors,
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Speaker 1 (2026-04-28_10_39_27)
everything is...
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Speaker 1 (2026-04-28_10_39_27)
Always the same.
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Speaker 1 (2026-04-28_10_39_27)
Age, smoking,
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Speaker 1 (2026-04-28_10_39_27)
diabetes,
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Speaker 1 (2026-04-28_10_39_27)
ideal cholesterol and hypertension.
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Speaker 1 (2026-04-28_10_39_27)
This free hypertension,
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Speaker 1 (2026-04-28_10_39_27)
dyslipidia and diabetes will treat usually with medicaments.
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Speaker 1 (2026-04-28_10_39_27)
Presentary type of life and overweight.
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Speaker 1 (2026-04-28_10_39_27)
Nobody has overweight except me.
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Speaker 1 (2026-04-28_10_39_27)
That's good.
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Speaker 1 (2026-04-28_10_39_27)
So we will have in your future take care of
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Speaker 1 (2026-04-28_10_39_27)
you to have some active life.
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Speaker 1 (2026-04-28_10_39_27)
schedule some aerob or anaerobic exercise to
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Speaker 1 (2026-04-28_10_39_27)
not to be overweight because it's silly doctor with
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Speaker 1 (2026-04-28_10_39_27)
130 kilos say to somebody you should lose your weight
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Speaker 1 (2026-04-28_10_39_27)
because it's not good yes it's not good tobacco how many
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Speaker 1 (2026-04-28_10_39_27)
of you smokes today nobody that's
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Speaker 1 (2026-04-28_10_39_27)
good i asked this question 20 years maybe somebody
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Speaker 1 (2026-04-28_10_39_27)
I asked this question 20 years and less and less hands
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Speaker 1 (2026-04-28_10_39_27)
are right up,
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Speaker 1 (2026-04-28_10_39_27)
which is good,
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Speaker 1 (2026-04-28_10_39_27)
because really tobacco smoking is one
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Speaker 1 (2026-04-28_10_39_27)
of the preventable factors of atherosclerosis.
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Speaker 1 (2026-04-28_10_39_27)
I
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Speaker 1 (2026-04-28_10_39_27)
don't think so,
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Speaker 1 (2026-04-28_10_39_27)
but pathophysiologically,
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Speaker 1 (2026-04-28_10_39_27)
the nicotine is the agent that can contribute
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Speaker 1 (2026-04-28_10_39_27)
to atherosclerosis.
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Speaker 1 (2026-04-28_10_39_27)
that I think your risk of atherosclerosis will be
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Speaker 1 (2026-04-28_10_39_27)
higher and we cardiologists will have work.
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Speaker 1 (2026-04-28_10_39_27)
So that's for us,
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Speaker 1 (2026-04-28_10_39_27)
for you not.
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Speaker 1 (2026-04-28_10_39_27)
So without smoking,
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Speaker 1 (2026-04-28_10_39_27)
so with smoking,
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Speaker 1 (2026-04-28_10_39_27)
the
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Speaker 1 (2026-04-28_10_39_27)
lungs and COPD is present.
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Speaker 1 (2026-04-28_10_39_27)
Without smoking,
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Speaker 1 (2026-04-28_10_39_27)
we will not have lung problem,
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Speaker 1 (2026-04-28_10_39_27)
but atherosclerosis,
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Speaker 1 (2026-04-28_10_39_27)
it's probably that yes.
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Speaker 1 (2026-04-28_10_39_27)
Angina.
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Speaker 1 (2026-04-28_10_39_27)
Typical angina meets three criteria.
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Speaker 1 (2026-04-28_10_39_27)
Substantial chest discomfort with characteristic quality and duration,
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Speaker 1 (2026-04-28_10_39_27)
which is provoked by exertional or emotional stress and relieved
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Speaker 1 (2026-04-28_10_39_27)
by rest of nitroglycerin.
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Speaker 1 (2026-04-28_10_39_27)
Probable angina or atypical angina meets two of
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Speaker 1 (2026-04-28_10_39_27)
probable characteristics.
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Speaker 1 (2026-04-28_10_39_27)
All others is chest pain.
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Speaker 1 (2026-04-28_10_39_27)
Description.
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Speaker 1 (2026-04-28_10_39_27)
Typical chest pain or typical angina is located sub -sternally,
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Speaker 1 (2026-04-28_10_39_27)
but it can be located anywhere,
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Speaker 1 (2026-04-28_10_39_27)
from the epigastrium up to the neck.
8:14
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Speaker 1 (2026-04-28_10_39_27)
Usually,
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Speaker 1 (2026-04-28_10_39_27)
it radiates down the arms on the left side.
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Speaker 1 (2026-04-28_10_39_27)
From the quality,
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Speaker 1 (2026-04-28_10_39_27)
it's more deep distraught pressure or squeezing sensation
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Speaker 1 (2026-04-28_10_39_27)
than stable pain.
8:26
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Speaker 1 (2026-04-28_10_39_27)
Somebody will say,
8:28
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Speaker 1 (2026-04-28_10_39_27)
I have heart attack,
8:30
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Speaker 1 (2026-04-28_10_39_27)
I have my pelvic infarction on my heart.
8:39
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Speaker 1 (2026-04-28_10_39_27)
So,
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Speaker 1 (2026-04-28_10_39_27)
angina,
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Speaker 1 (2026-04-28_10_39_27)
squeezing sensation.
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Speaker 1 (2026-04-28_10_39_27)
Duration usually 10 to 30 seconds.
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Speaker 1 (2026-04-28_10_39_27)
And you ask the patient for inciting factors,
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Speaker 1 (2026-04-28_10_39_27)
usually physical activity,
8:48
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Speaker 1 (2026-04-28_10_39_27)
emotions,
8:50
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Speaker 1 (2026-04-28_10_39_27)
eating or cold weather.
8:51
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Speaker 1 (2026-04-28_10_39_27)
So,
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Speaker 1 (2026-04-28_10_39_27)
old man, after eating big dinner,
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Speaker 1 (2026-04-28_10_39_27)
outside is cold.
8:57
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Speaker 1 (2026-04-28_10_39_27)
When he went outside and had chest pain,
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Speaker 1 (2026-04-28_10_39_27)
very probable,
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Speaker 1 (2026-04-28_10_39_27)
typical angina.
9:07
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Speaker 1 (2026-04-28_10_39_27)
In medicine,
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Speaker 1 (2026-04-28_10_39_27)
we would like to measure everything.
9:10
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Speaker 1 (2026-04-28_10_39_27)
The angina is the same.
9:11
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Speaker 1 (2026-04-28_10_39_27)
These are grades.
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Speaker 1 (2026-04-28_10_39_27)
Angina stayed by Canadian Cardiovascular Society.
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Speaker 1 (2026-04-28_10_39_27)
The same grades are for dyspnea.
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Speaker 1 (2026-04-28_10_39_27)
First grade,
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Speaker 1 (2026-04-28_10_39_27)
usually no problem with ordinary physical activity.
9:24
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Speaker 1 (2026-04-28_10_39_27)
Fourth grade,
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Speaker 1 (2026-04-28_10_39_27)
the angina may be addressed for very,
9:27
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Speaker 1 (2026-04-28_10_39_27)
very small activity.
9:28
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Speaker 1 (2026-04-28_10_39_27)
Distinguishing between second and third grade in our
9:32
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Speaker 1 (2026-04-28_10_39_27)
country is better by clamping the floors.
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Speaker 1 (2026-04-28_10_39_27)
If somebody will say to you that I went to China,
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Speaker 1 (2026-04-28_10_39_27)
if I went from my home to the shop,
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Speaker 1 (2026-04-28_10_39_27)
you don't know if you don't know this patient in the village
9:44
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Speaker 1 (2026-04-28_10_39_27)
there, how long it is,
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Speaker 1 (2026-04-28_10_39_27)
how steep it is.
9:47
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Speaker 1 (2026-04-28_10_39_27)
But the floors are more than less the same.
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Speaker 1 (2026-04-28_10_39_27)
If somebody climbed more than two floors,
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Speaker 1 (2026-04-28_10_39_27)
it's second grade.
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Speaker 1 (2026-04-28_10_39_27)
If less than two floors,
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Speaker 1 (2026-04-28_10_39_27)
something like one floor,
9:57
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Speaker 1 (2026-04-28_10_39_27)
it's third grade.
10:00
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Speaker 2 (2026-04-28_10_39_27)
We speak today about stable angina,
10:02
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Speaker 2 (2026-04-28_10_39_27)
two months and about,
10:03
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Speaker 2 (2026-04-28_10_39_27)
usually in some kind of exertion.
10:07
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Speaker 2 (2026-04-28_10_39_27)
Everything else is unstable angina,
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Speaker 2 (2026-04-28_10_39_27)
so new onset angina or prior angina with increasing
10:15
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Speaker 2 (2026-04-28_10_39_27)
severity.
10:16
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Speaker 2 (2026-04-28_10_39_27)
We take this as acute coronary syndrome and try to treat as
10:20
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Speaker 2 (2026-04-28_10_39_27)
soon as possible.
10:23
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Speaker 2 (2026-04-28_10_39_27)
Maybe a lot of our patients have some silent episodes of ischemia
10:27
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Speaker 2 (2026-04-28_10_39_27)
and they do not know about it.
10:30
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Speaker 2 (2026-04-28_10_39_27)
If you do alter monitoring these patients,
10:34
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Speaker 2 (2026-04-28_10_39_27)
you will find some ST -segment depression up to 40 % of
10:38
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Speaker 1 (2026-04-28_10_39_27)
the patients.
10:39
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Speaker 2 (2026-04-28_10_39_27)
Probably less severe ischemia or some kind of neuropathy
10:43
S…
Speaker 2 (2026-04-28_10_39_27)
for diabetic patients,
10:45
S…
Speaker 2 (2026-04-28_10_39_27)
but I think it contributes to the diseases.
10:50
S…
Speaker 2 (2026-04-28_10_39_27)
What we use in diagnosis?
10:51
S…
Speaker 2 (2026-04-28_10_39_27)
Of course,
10:52
S…
Speaker 2 (2026-04-28_10_39_27)
ICG.
10:53
S…
Speaker 2 (2026-04-28_10_39_27)
12 -foot ICG we started.
10:54
S…
Speaker 2 (2026-04-28_10_39_27)
We go anywhere to the internal department of
10:58
S…
Speaker 2 (2026-04-28_10_39_27)
the cardiology.
10:59
S…
Speaker 2 (2026-04-28_10_39_27)
First thing will be ICG.
11:00
S…
Speaker 2 (2026-04-28_10_39_27)
Unfortunately,
11:02
S…
Speaker 2 (2026-04-28_10_39_27)
it could be normal in the 50 % of the patients.
11:05
S…
Speaker 2 (2026-04-28_10_39_27)
You look for QF changes for the ACP segment elevation depression.
11:10
S…
Speaker 2 (2026-04-28_10_39_27)
Second thing,
11:11
S…
Speaker 2 (2026-04-28_10_39_27)
echocardiography,
11:13
S…
Speaker 2 (2026-04-28_10_39_27)
the examination for regional
11:17
S…
Speaker 2 (2026-04-28_10_39_27)
or global wall motion abnormalities,
11:19
S…
Speaker 2 (2026-04-28_10_39_27)
or you will look for impaired systolic LV function.
11:23
S…
Speaker 2 (2026-04-28_10_39_27)
I think echocardiography should
11:27
S…
Speaker 2 (2026-04-28_10_39_27)
be second line or together with ACG
11:31
S…
Speaker 2 (2026-04-28_10_39_27)
on the beginning of examination.
11:33
S…
Speaker 2 (2026-04-28_10_39_27)
Some ACGs,
11:36
S…
Speaker 2 (2026-04-28_10_39_27)
so image that is 80 years old man with typical angina.
11:41
S…
Speaker 2 (2026-04-28_10_39_27)
you should say something about probability of coronary artery disease
11:46
S…
Speaker 1 (2026-04-28_10_39_27)
for him.
11:46
S…
Speaker 2 (2026-04-28_10_39_27)
Is it probable that he has coronary artery disease or not?
11:50
S…
Speaker 1 (2026-04-28_10_39_27)
You cannot say,
11:54
S…
Speaker 2 (2026-04-28_10_39_27)
okay. Some others?
11:55
S…
Speaker 1 (2026-04-28_10_39_27)
Sorry?
11:59
S…
Speaker 2 (2026-04-28_10_39_27)
So it's probable
12:04
S…
Speaker 1 (2026-04-28_10_39_27)
that...
12:04
S…
Speaker 2 (2026-04-28_10_39_27)
But based on this ACG,
12:06
S…
Speaker 2 (2026-04-28_10_39_27)
you can say that the probability is higher or...
12:12
S…
Speaker 2 (2026-04-28_10_39_27)
Is there anything on the ACG?
12:14
S…
Speaker 2 (2026-04-28_10_39_27)
What can you lead to the coronary artery disease?
12:20
S…
Speaker 2 (2026-04-28_10_39_27)
So I saw,
12:22
S…
Speaker 2 (2026-04-28_10_39_27)
I said that we spoke or that we look for ST
12:26
S…
Speaker 1 (2026-04-28_10_39_27)
segment elevation depression.
12:27
S…
Speaker 2 (2026-04-28_10_39_27)
They are more acute.
12:29
S…
Speaker 2 (2026-04-28_10_39_27)
You see ST segment elevation acute coronary syndrome very probable.
12:33
S…
Speaker 2 (2026-04-28_10_39_27)
Depression like sub -endocardial ischemic can be
12:37
S…
Speaker 1 (2026-04-28_10_39_27)
chronic as well,
12:40
S…
Speaker 2 (2026-04-28_10_39_27)
but few wave changes as outcome
12:44
S…
Speaker 2 (2026-04-28_10_39_27)
from ST segment elevation myocardial infarction.
12:49
S…
Speaker 2 (2026-04-28_10_39_27)
If you look carefully,
12:50
S…
Speaker 2 (2026-04-28_10_39_27)
you see this Q wave in lead 3,
12:52
S…
Speaker 2 (2026-04-28_10_39_27)
AVF,
12:53
S…
Speaker 1 (2026-04-28_10_39_27)
and 2.
12:54
S…
Speaker 2 (2026-04-28_10_39_27)
So you can be sure that this man,
12:58
S…
Speaker 2 (2026-04-28_10_39_27)
almost sure,
12:59
S…
Speaker 2 (2026-04-28_10_39_27)
99%,
13:00
S…
Speaker 2 (2026-04-28_10_39_27)
that this man had myocardial infarction on the inferior wall sometimes
13:05
S…
Speaker 2 (2026-04-28_10_39_27)
in the past.
13:05
S…
Speaker 2 (2026-04-28_10_39_27)
It could be one month,
13:07
S…
Speaker 2 (2026-04-28_10_39_27)
it could be five years.
13:08
S…
Speaker 1 (2026-04-28_10_39_27)
Okay,
13:10
S…
Speaker 1 (2026-04-28_10_39_27)
another patient,
13:11
S…
Speaker 2 (2026-04-28_10_39_27)
another ECG.
13:12
S…
Speaker 2 (2026-04-28_10_39_27)
Q wave changes,
13:14
S…
Speaker 2 (2026-04-28_10_39_27)
ST segment elevation,
13:15
S…
Speaker 1 (2026-04-28_10_39_27)
depression.
13:15
S…
Speaker 1 (2026-04-28_10_39_27)
3
13:28
S…
Speaker 2 (2026-04-28_10_39_27)
or V50?
13:30
S…
Speaker 1 (2026-04-28_10_39_27)
I think...
13:33
S…
Speaker 2 (2026-04-28_10_39_27)
This is maybe more like artifact.
13:37
S…
Speaker 2 (2026-04-28_10_39_27)
But yes,
13:38
S…
Speaker 2 (2026-04-28_10_39_27)
you are right.
13:39
S…
Speaker 2 (2026-04-28_10_39_27)
The ST segment here is elevated.
13:41
S…
Speaker 2 (2026-04-28_10_39_27)
Here as well.
13:43
S…
Speaker 2 (2026-04-28_10_39_27)
Probably chronic changes like aneurysma on the anterior wall.
13:47
S…
Speaker 2 (2026-04-28_10_39_27)
But first thing you should say is Q wave.
13:50
S…
Speaker 2 (2026-04-28_10_39_27)
V1 up to V5 or V6.
13:54
S…
Speaker 2 (2026-04-28_10_39_27)
So huge myocardial infarction on the anterior wall.
13:58
S…
Speaker 1 (2026-04-28_10_39_27)
Okay.
14:01
S…
Speaker 2 (2026-04-28_10_39_27)
Now you are trained.
14:02
S…
Speaker 2 (2026-04-28_10_39_27)
Q wave,
14:04
S…
Speaker 1 (2026-04-28_10_39_27)
elevation depression.
14:08
S…
Speaker 1 (2026-04-28_10_39_27)
Depression.
14:09
S…
Speaker 1 (2026-04-28_10_39_27)
Elevation.
14:12
S…
Speaker 1 (2026-04-28_10_39_27)
White
14:19
S…
Speaker 1 (2026-04-28_10_39_27)
QRS complex.
14:19
S…
Speaker 2 (2026-04-28_10_39_27)
First thing you should say,
14:22
S…
Speaker 2 (2026-04-28_10_39_27)
it's white QRS complex.
14:23
S…
Speaker 2 (2026-04-28_10_39_27)
Then you will follow probably bundle branch block.
14:27
S…
Speaker 2 (2026-04-28_10_39_27)
Then you have time to think of left or right,
14:31
S…
Speaker 2 (2026-04-28_10_39_27)
50 % chance.
14:32
S…
Speaker 1 (2026-04-28_10_39_27)
This is left or right bundle branch block.
14:35
S…
Speaker 1 (2026-04-28_10_39_27)
No.
14:42
S…
Speaker 2 (2026-04-28_10_39_27)
QS in V1 and RS in V6 is left bundle
14:46
S…
Speaker 2 (2026-04-28_10_39_27)
branch block and this is strange in
14:51
S…
Speaker 2 (2026-04-28_10_39_27)
left bundle branch block or right can be Q
14:55
S…
Speaker 2 (2026-04-28_10_39_27)
waves elevation depression and not necessary based on ischemia.
15:00
S…
Speaker 1 (2026-04-28_10_39_27)
There are people with left -handle branch block without dyschemia,
15:03
S…
Speaker 1 (2026-04-28_10_39_27)
so be careful of wideness of QRS complex.
15:07
S…
Speaker 1 (2026-04-28_10_39_27)
Next possibility,
15:09
S…
Speaker 1 (2026-04-28_10_39_27)
echocardiography.
15:10
S…
Speaker 1 (2026-04-28_10_39_27)
Two echoes,
15:12
S…
Speaker 1 (2026-04-28_10_39_27)
this is one patient,
15:13
S…
Speaker 1 (2026-04-28_10_39_27)
this is second patient,
15:14
S…
Speaker 1 (2026-04-28_10_39_27)
four chambers,
15:15
S…
Speaker 1 (2026-04-28_10_39_27)
right ventricle,
15:17
S…
Speaker 1 (2026-04-28_10_39_27)
right atrium,
15:18
S…
Speaker 1 (2026-04-28_10_39_27)
left atrium,
15:19
S…
Speaker 1 (2026-04-28_10_39_27)
left ventricle.
15:21
S…
Speaker 1 (2026-04-28_10_39_27)
The same heart with the Doppler image film you see.
15:24
S…
Speaker 1 (2026-04-28_10_39_27)
If you compare the left ventricle,
15:28
S…
Speaker 1 (2026-04-28_10_39_27)
this one and this one.
15:30
S…
Speaker 1 (2026-04-28_10_39_27)
One is normal,
15:31
S…
Speaker 1 (2026-04-28_10_39_27)
the second not normal.
15:32
S…
Speaker 1 (2026-04-28_10_39_27)
You can clearly see that the ejection
15:36
S…
Speaker 1 (2026-04-28_10_39_27)
fraction on this ventricle
15:40
S…
Speaker 1 (2026-04-28_10_39_27)
is something like 50 -60%.
15:43
S…
Speaker 1 (2026-04-28_10_39_27)
This is 30%,
15:45
S…
Speaker 1 (2026-04-28_10_39_27)
maybe less.
15:46
S…
Speaker 1 (2026-04-28_10_39_27)
If you see the mitral valve in
15:50
S…
Speaker 1 (2026-04-28_10_39_27)
the blood,
15:51
S…
Speaker 1 (2026-04-28_10_39_27)
it is coming from atrium to the ventricle,
15:54
S…
Speaker 1 (2026-04-28_10_39_27)
and then it is going up,
15:55
S…
Speaker 1 (2026-04-28_10_39_27)
down, out,
15:56
S…
Speaker 1 (2026-04-28_10_39_27)
down.
15:56
S…
Speaker 1 (2026-04-28_10_39_27)
Mitral regurgitation.
16:00
S…
Speaker 1 (2026-04-28_10_39_27)
Normal,
16:01
S…
Speaker 1 (2026-04-28_10_39_27)
abnormal,
16:02
S…
Speaker 1 (2026-04-28_10_39_27)
left ventricle dilatation with low ejection fraction.
16:05
S…
Speaker 1 (2026-04-28_10_39_27)
Okay,
16:07
S…
Speaker 1 (2026-04-28_10_39_27)
if you are not sure,
16:08
S…
Speaker 1 (2026-04-28_10_39_27)
stress test.
16:09
S…
Speaker 1 (2026-04-28_10_39_27)
The stress test usually we use exercise,
16:12
S…
Speaker 1 (2026-04-28_10_39_27)
ACG stress test with ergometry.
16:14
S…
Speaker 1 (2026-04-28_10_39_27)
Quite long
16:20
S…
Speaker 1 (2026-04-28_10_39_27)
examination,
16:20
S…
Speaker 1 (2026-04-28_10_39_27)
it takes up to half an hour.
16:23
S…
Speaker 1 (2026-04-28_10_39_27)
You see,
16:24
S…
Speaker 1 (2026-04-28_10_39_27)
or you can see on the normal ACG at the beginning,
16:27
S…
Speaker 1 (2026-04-28_10_39_27)
during the increasing of the heart rate,
16:30
S…
Speaker 1 (2026-04-28_10_39_27)
some elevation or depression.
16:31
S…
Speaker 1 (2026-04-28_10_39_27)
The same in echocardiography.
16:34
S…
Speaker 1 (2026-04-28_10_39_27)
In echocardiography,
16:36
S…
Speaker 1 (2026-04-28_10_39_27)
it's not easy to increase heart rate with ergometer,
16:39
S…
Speaker 1 (2026-04-28_10_39_27)
so we use dobutamine.
16:40
S…
Speaker 1 (2026-04-28_10_39_27)
Dobutamine is increased heart rate,
16:42
S…
Speaker 1 (2026-04-28_10_39_27)
and LV segment,
16:44
S…
Speaker 1 (2026-04-28_10_39_27)
which was normal at baseline,
16:46
S…
Speaker 1 (2026-04-28_10_39_27)
could be during the dobutamine or during heart rate with
16:50
S…
Speaker 1 (2026-04-28_10_39_27)
some...
16:53
S…
Speaker 1 (2026-04-28_10_39_27)
hypokinesis,
16:53
S…
Speaker 1 (2026-04-28_10_39_27)
hyperkinesis,
16:54
S…
Speaker 1 (2026-04-28_10_39_27)
etc. Again,
16:56
S…
Speaker 1 (2026-04-28_10_39_27)
a few pictures.
16:57
S…
Speaker 1 (2026-04-28_10_39_27)
Normally, if you're in the beginning of the stress test,
17:00
S…
Speaker 1 (2026-04-28_10_39_27)
after just 20 watts,
17:03
S…
Speaker 1 (2026-04-28_10_39_27)
you see elevation on the lateral ball.
17:06
S…
Speaker 1 (2026-04-28_10_39_27)
This is baseline ACG during the exercise.
17:10
S…
Speaker 1 (2026-04-28_10_39_27)
The same with another patient here with
17:15
S…
Speaker 1 (2026-04-28_10_39_27)
some...
17:17
S…
Speaker 1 (2026-04-28_10_39_27)
Markable ST segment depression.
17:20
S…
Speaker 1 (2026-04-28_10_39_27)
At that time,
17:21
S…
Speaker 1 (2026-04-28_10_39_27)
we should exercise and send the patients to coronary angiography.
17:25
S…
Speaker 1 (2026-04-28_10_39_27)
Problem is the sensitivity.
17:27
S…
Speaker 1 (2026-04-28_10_39_27)
ACG stress test has only 50 %
17:31
S…
Speaker 1 (2026-04-28_10_39_27)
sensitivity.
17:31
S…
Speaker 1 (2026-04-28_10_39_27)
Specificity is something like 70%.
17:35
S…
Speaker 1 (2026-04-28_10_39_27)
Echocardiography stress test is a little bit better,
17:37
S…
Speaker 1 (2026-04-28_10_39_27)
85%.
17:39
S…
Speaker 1 (2026-04-28_10_39_27)
What next?
17:41
S…
Speaker 1 (2026-04-28_10_39_27)
We would like to offer this examination for the patient with some pain
17:45
S…
Speaker 1 (2026-04-28_10_39_27)
and pathological non -immunalsic tests with pain and
17:50
S…
Speaker 1 (2026-04-28_10_39_27)
high clinical probability like smoking,
17:52
S…
Speaker 1 (2026-04-28_10_39_27)
obese patient,
17:53
S…
Speaker 1 (2026-04-28_10_39_27)
family history,
17:54
S…
Speaker 1 (2026-04-28_10_39_27)
male, sometimes for low ejection fraction from
17:59
S…
Speaker 1 (2026-04-28_10_39_27)
differential diagnosis.
18:00
S…
Speaker 1 (2026-04-28_10_39_27)
And we would like to identify high risk patient where the
18:04
S…
Speaker 1 (2026-04-28_10_39_27)
angiography and revascularization might improve outcome.
18:09
S…
Speaker 1 (2026-04-28_10_39_27)
Two possibilities for non -invasive coronary angiography,
18:12
S…
Speaker 1 (2026-04-28_10_39_27)
CT -based or invasive coronary angiography.
18:16
S…
Speaker 1 (2026-04-28_10_39_27)
Non -invasive I will use in the case where I would
18:21
S…
Speaker 1 (2026-04-28_10_39_27)
like to exclude coronary angiogram.
18:23
S…
Speaker 1 (2026-04-28_10_39_27)
If I expect that there is some severe stenosis,
18:26
S…
Speaker 1 (2026-04-28_10_39_27)
it has no sense to make coronary angiogram with CT because
18:30
S…
Speaker 1 (2026-04-28_10_39_27)
you need then elascularization.
18:32
S…
Speaker 1 (2026-04-28_10_39_27)
Coronary arteries,
18:35
S…
Speaker 1 (2026-04-28_10_39_27)
left -hand coronary artery.
18:38
S…
Speaker 1 (2026-04-28_10_39_27)
The complex artery,
18:39
S…
Speaker 1 (2026-04-28_10_39_27)
anterior descending artery,
18:41
S…
Speaker 1 (2026-04-28_10_39_27)
right coronary artery,
18:43
S…
Speaker 1 (2026-04-28_10_39_27)
there is a lot of variation.
18:45
S…
Speaker 1 (2026-04-28_10_39_27)
But what is the idea is to describe how many arteries are
18:49
S…
Speaker 1 (2026-04-28_10_39_27)
affected.
18:49
S…
Speaker 1 (2026-04-28_10_39_27)
If somebody has single vessel disease,
18:52
S…
Speaker 1 (2026-04-28_10_39_27)
the outcome is better.
18:53
S…
Speaker 1 (2026-04-28_10_39_27)
If there is three vessel disease,
18:55
S…
Speaker 1 (2026-04-28_10_39_27)
the outcome is worse.
18:56
S…
Speaker 1 (2026-04-28_10_39_27)
What would we like
19:00
S…
Speaker 1 (2026-04-28_10_39_27)
to treat?
19:02
S…
Speaker 1 (2026-04-28_10_39_27)
We would like to treat this angina to reduce symptoms,
19:05
S…
Speaker 1 (2026-04-28_10_39_27)
angina or chest pain or dyspnea,
19:07
S…
Speaker 1 (2026-04-28_10_39_27)
and to reduce risk of mortality and morbidity.
19:12
S…
Speaker 1 (2026-04-28_10_39_27)
Which are our possibilities?
19:14
S…
Speaker 1 (2026-04-28_10_39_27)
So first,
19:14
S…
Speaker 1 (2026-04-28_10_39_27)
non -pharmacological approach,
19:17
S…
Speaker 1 (2026-04-28_10_39_27)
revascularization.
19:18
S…
Speaker 1 (2026-04-28_10_39_27)
PCI percutaneous coronary intervention or coronary
19:23
S…
Speaker 1 (2026-04-28_10_39_27)
artery bypass grafting.
19:28
S…
Speaker 1 (2026-04-28_10_39_27)
50 years we changed.
19:29
S…
Speaker 1 (2026-04-28_10_39_27)
Before,
19:30
S…
Speaker 1 (2026-04-28_10_39_27)
more coronary artery bypass grafting.
19:34
S…
Speaker 1 (2026-04-28_10_39_27)
Now we try to do more PCI because it's invasive.
19:38
S…
Speaker 1 (2026-04-28_10_39_27)
Heart transplantation as a treatment
19:42
S…
Speaker 1 (2026-04-28_10_39_27)
of end stage of the heart disease is nice option,
19:45
S…
Speaker 1 (2026-04-28_10_39_27)
but we have a lot of patients and not too much to notice.
19:49
S…
Speaker 1 (2026-04-28_10_39_27)
Pharmacological treatment goes through
19:54
S…
Speaker 1 (2026-04-28_10_39_27)
beta -blockers,
19:54
S…
Speaker 1 (2026-04-28_10_39_27)
through anti -fatellite agents,
19:56
S…
Speaker 1 (2026-04-28_10_39_27)
lipid -lowering agents,
19:58
S…
Speaker 1 (2026-04-28_10_39_27)
some easy inhibitors.
20:05
S…
Speaker 1 (2026-04-28_10_39_27)
Prevascularization.
20:05
S…
Speaker 2 (2026-04-28_10_39_27)
Again,
20:07
S…
Speaker 1 (2026-04-28_10_39_27)
I have to state that we are speaking about chronic coronary artery disease.
20:10
S…
Speaker 1 (2026-04-28_10_39_27)
If you have somebody with acute coronary artery disease,
20:14
S…
Speaker 1 (2026-04-28_10_39_27)
then the revascularization is the first light option almost
20:18
S…
Speaker 2 (2026-04-28_10_39_27)
always.
20:19
S…
Speaker 1 (2026-04-28_10_39_27)
But in chronic,
20:20
S…
Speaker 1 (2026-04-28_10_39_27)
you would like to treat some symptoms of the patients
20:24
S…
Speaker 1 (2026-04-28_10_39_27)
or some objective signs of ischemia.
20:26
S…
Speaker 1 (2026-04-28_10_39_27)
Indication for PCR or to
20:30
S…
Speaker 1 (2026-04-28_10_39_27)
cabbage may vary little bit from one center to another.
20:34
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Speaker 1 (2026-04-28_10_39_27)
We are cardiologists,
20:35
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Speaker 1 (2026-04-28_10_39_27)
we refer to do PCI.
20:39
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Speaker 1 (2026-04-28_10_39_27)
If you will be on the surgery inside
20:43
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Speaker 1 (2026-04-28_10_39_27)
the hospital,
20:44
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Speaker 1 (2026-04-28_10_39_27)
maybe the physician there will say,
20:47
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Speaker 1 (2026-04-28_10_39_27)
okay, a lot of things can be done by CABG.
20:52
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Speaker 1 (2026-04-28_10_39_27)
For me,
20:53
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Speaker 1 (2026-04-28_10_39_27)
I think it's what is less invasive,
20:56
S…
Speaker 1 (2026-04-28_10_39_27)
it is more better for the patient.
21:02
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Speaker 1 (2026-04-28_10_39_27)
PCI for single vessel disease.
21:03
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Speaker 1 (2026-04-28_10_39_27)
One vessel affected,
21:05
S…
Speaker 1 (2026-04-28_10_39_27)
PCI was nice.
21:06
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Speaker 1 (2026-04-28_10_39_27)
If there was three vessel disease
21:10
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Speaker 1 (2026-04-28_10_39_27)
or left main disease,
21:12
S…
Speaker 1 (2026-04-28_10_39_27)
and you will do balloon dilatation of left main disease,
21:15
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Speaker 1 (2026-04-28_10_39_27)
you will stop the blood for a huge
21:19
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Speaker 1 (2026-04-28_10_39_27)
part of the left ventricle for a few seconds.
21:21
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Speaker 2 (2026-04-28_10_39_27)
And,
21:22
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Speaker 2 (2026-04-28_10_39_27)
of course,
21:23
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Speaker 1 (2026-04-28_10_39_27)
it can be very harmful for the patient.
21:25
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Speaker 1 (2026-04-28_10_39_27)
So, ten years ago,
21:28
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Speaker 1 (2026-04-28_10_39_27)
three vessel disease.
21:31
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Speaker 1 (2026-04-28_10_39_27)
for CABG.
21:32
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Speaker 1 (2026-04-28_10_39_27)
Now,
21:33
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Speaker 1 (2026-04-28_10_39_27)
the possibility of some circulatory support with ECMO
21:37
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Speaker 1 (2026-04-28_10_39_27)
or with impella,
21:38
S…
Speaker 1 (2026-04-28_10_39_27)
we can do PCI on the left main disease as
21:43
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Speaker 1 (2026-04-28_10_39_27)
well.
21:43
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Speaker 2 (2026-04-28_10_39_27)
So,
21:44
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Speaker 2 (2026-04-28_10_39_27)
again,
21:45
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Speaker 1 (2026-04-28_10_39_27)
more and more patients can be treated with PCI.
21:47
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Speaker 1 (2026-04-28_10_39_27)
How it looks practically,
21:50
S…
Speaker 1 (2026-04-28_10_39_27)
on the top patient with
21:54
S…
Speaker 1 (2026-04-28_10_39_27)
single vessel disease,
21:55
S…
Speaker 1 (2026-04-28_10_39_27)
you find this ramus circumflexus
21:59
S…
Speaker 1 (2026-04-28_10_39_27)
here with
22:02
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Speaker 1 (2026-04-28_10_39_27)
severe stenosis right coronary artery without problems another
22:06
S…
Speaker 1 (2026-04-28_10_39_27)
patient three vessel disease one stenosis second stenosis
22:10
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Speaker 1 (2026-04-28_10_39_27)
more likely i will send the patient
22:15
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Speaker 1 (2026-04-28_10_39_27)
on the bottom to the coronary artery bypass crafting
22:21
S…
Speaker 1 (2026-04-28_10_39_27)
PCI is a very nice procedure.
22:23
S…
Speaker 1 (2026-04-28_10_39_27)
We started with the femoral artery.
22:25
S…
Speaker 1 (2026-04-28_10_39_27)
Now we do 90 % or 95 % through the sheet
22:29
S…
Speaker 1 (2026-04-28_10_39_27)
in the radial or brachial artery.
22:32
S…
Speaker 1 (2026-04-28_10_39_27)
It leads to the...
22:34
S…
Speaker 1 (2026-04-28_10_39_27)
We kill,
22:35
S…
Speaker 1 (2026-04-28_10_39_27)
so the patients before with femoral punctions have
22:40
S…
Speaker 1 (2026-04-28_10_39_27)
to lie 24 hours and 12 hours on the bed.
22:44
S…
Speaker 1 (2026-04-28_10_39_27)
Nowadays,
22:44
S…
Speaker 1 (2026-04-28_10_39_27)
they can stand after a few hours with some pressure on
22:48
S…
Speaker 1 (2026-04-28_10_39_27)
the radial or brachial artery.
Эта запись была составлена АИ (автоматическое распознавание речи). Политика МА
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