Tuesday, April 15, 2014

Angiogram

To be performed the day after tomorrow:

What is an angiogram?

An angiogram is an X-ray image of blood vessels after they are filled with a contrast material. An angiogram of the heart, a coronary angiogram, is the "gold standard" for the evaluation of coronary artery disease (CAD). A coronary angiogram can be used to identify the exact location and severity of CAD.

How is a coronary angiogram performed?

Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not significantly uncomfortable.
  • In performing a coronary angiogram, a doctor inserts a small catheter(a thin hollow tube with a diameter of 2-3 mm) through the skin into an artery in either the groin or the arm.
  • Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of thecoronary arteries (the blood vessels supplying blood to the heart).
  • Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with X-ray images) is injected into each coronary artery. The images that are produced are called the angiogram.
  • The procedure takes approximately 20-30 minutes.
  • After the procedure, the catheter is removed and the artery in the leg or arm is either sutured, "sealed," or treated with manual compression to prevent bleeding.
  • Often, if an angioplasty orstent is indicated, it will be performed as part of the same procedure.

What does a coronary angiogram demonstrate?

Angiographic images accurately reveal the extent and severity of all coronary artery blockages. For patients with severe angina or heart attack(myocardial infarction), or those who have markedly abnormal noninvasive tests for CAD (such as stress tests), the angiogram also helps the doctor select the optimal treatment. Treatments may then include medications, balloon angioplasty, coronary stenting, atherectomy ("roto-rooter"), or coronary artery bypass surgery.


Friday, April 11, 2014



Bangladesh seminar April 1, see http://www.thedailystar.net/dialogue-a-must-to-uphold-rights-18361

Thursday, March 20, 2014

Immigration Bill

Eleven contributions on the Immigration Bill Committee stage yesterday, including a win for certain illegitimate children: http://bit.ly/1l8lmHS

Haematology

Blood test yesterday:

Plt             535 (638)
Hb              10.4 (10.4)
WBC            5.3 (6.5)

There bis no explanation why the platelets have improved with no change in the hydroxycarbamide dose, but it simply means the dose is kept at its present level. It would be unfortunate if the platelets did start rising, as a higher dose would cause a reduction in the level of haemoglobin.

Tuesday, March 11, 2014

Vascular surgery

Consultation with Mr R March 5:

".... The duplex scan today confirmed that his aneurysn is now only 3.3 cn in diameter without any endoleak".

" Mr S booked him for an angioplasty of his left leg, since he has a short segment occlusion of the femoral artery at tthe adductor canal. However, I am not convinced that his symptoms at this stage justify intervention. He is not complaining of rest pain, ulceration or gangrene, ie critical leg ischaemia. I have therefore cancelled his angioplasty".

Mtr R's assessment of the risk of angioplasty appeared to be a good deal higher than Mr S's, so I have to put up with pain in the leg if I walk at a normal speed.

Wednesday, February 05, 2014

Haematologgy

Recent posts seem to be all about medical, but I'm still fairly active in the House, see http://bit.ly/1epmi7F Question on the Government's failure to enforce their own policy on planning for Travellers, and yesterday I intervened about the policy for destruction of public documents, in the context of the revelations about the Indian government's request to us for military advice before the attack on the Sikh Golden Temple in 1984, http://bit.ly/MsNwyb

Blood test results (last time in brackets:

Hb       10.3  (9.5)
Plt        590   (593)
WBC  6.52   (4.16)

No idea why the WBC should be so much better. Results mean no change in medication.

Thursday, January 16, 2014

Cardiology


Report by Dr M December 11, 2013

I was... disappointed that he has developed exertional angina over the last three or four momths.

A chest x-ray performed last month showed evidence of chronic asirways disease but nothing else.

Clinic examination today was unremarkable, althouh he does have bilateral carotid bruits. BP was 139/60 mmHg and his resting 12-lead ECG is normal.

I have intensified [his] anti-anginal regime today by adding Imdur 30 mg daily. I will see him [on January 29, 2014] and if his angina persists then I will arrange a coronary graft angiogram. Vascular access may be a slight risk, given his long history of peripheral vascular disease and the need to perform an angiogram from the legs, .... but it may be that he has a stenosis of either a graft or a native coronary artery that is amenable to stenting and this is something we need to explore if medical treatment fails.