Education Sessions

 

2012 Education Sessions

Date Presenter Case Summary
14 February 2012 LAM Young female patient with cryptogenic stroke. Transthoracic and transesophageal echocardiography revealed prominent right to left bubble transfer with time course consistent with pulmonary transit. CT Chest revealed isolated pulmonary arteriovenous fistula. General discussion of bubble studies, interpretation issues, pulmonary arteriovenous fistulae (including hereditary hemorrhagic telangiectasia)
and potential for percutaneous closure.
21 February 2012 AJSC Professor Andrew Coats presented a lecture on Heart Failure with Preserved Ejection Fraction. The epidemiology was reviewed (compared with systolic dysfunction: older, greater prevalence women). Despite better survival than systolic dysfunction significant mortality compared with other cardiovascular disease. The evidence base for ACEI, ARB and beta-blockers were reviewed. The SENIORS trial was reviewed in detail. The trial was positive for the 14% relative risk reduction for cardiovascular mortality and cardiovascular hospitalisations for nebivolol versus standard care in an elderly group of patients with greater than previous trial female representation and extremes of hemodynamics and some insights into renal impairment. The ability to achieve target doses (higher than antihypertensive doses) was greater than other trials. The properties of nevibolol relative to other beta-blockers were also discussed, e.g. racemic, cardioselectivity, vasodilator. The presentation can found at this link.
28 February 2012 SH Meeting sponsored by Astra Zeneca. Presentation by Professor Steen Husted (Denmark) on the intersection between international guidelines for management of acute coronary syndromes(Europe, US, Canada, Australia) and the new antiplatelet agents: prasugrel and ticagrelor. A general overview was presented an highlights of TIMI-TRITON and PLATO with some subgroup analyses, particularly patients not undergoing invasive therapy, patients undergoing CABG and the elderly. A copy of the presentation (hardcopy given at the meeting) is available here.
2 March 2012 RN Aortic dissection presentation
2 March 2012 RP Constrictive pericarditis presentation
6 March 2012 SC Case presentation of symptomatic sinus node dysfunction in elderly female. Review of sinus node dysfunction: ECG manifestation (including sinoatrial block degrees esp type II), prevalence of concomitant AV node disease, indications for pacemaker therapy and discussion of rationale for modes of pacing were discussed.
13 March 2012 LOC Case presentation of non-bacterial thrombotic endocarditis as part of the cancer-related thrombosis spectrum. In venous thromboembolism in context of cancer the superiority of therapeutic enoxaparin over warfarin (even INR 3 to 4) was discussed. The prevalence of non-bacterial endocarditis, pathophysiological features, dominance of embolic phenomena over hemodynamic dysfunction were discussed. Non-malignant cause also discussed. The unusual aspects of the presented case included: urothelial cancer (compared with adenocarcinoma: breast and gastrointestinal) and mitral regurgitation in addition to embolic phenomena. Some questions not resolved: given prevalence of cancer diagnosis in the six months after an idiopathic venous thrombeombolism what is the appropriate evaluation of asymptomatic patient (cancer screening)? What is the optimal therapy for NBTE if continued problems on enoxaparin (and while treatment of primary process). The edited presentation is available here (case details removed for confidentiality)
20 March 2012 KL A presentation on clinician-led discharge was presented. A pilot project for patients undergoing percutaneous coronary intervention without complication was planned for for late April 2012.
27 March 2012 FS A case presentation of patient with neurological event with patent foramen ovale. A general discussion regarding patent foramen ovale: embryology, diagnosis, anatomical complexity and associations such as atrial septal aneurysm (frequency in Ebstein’s anomaly), potential clinical complications, epidemiology and case-control evidence wrt cryptogenic stroke and the recent Closure I trial.
3 April 2012 LAM Case presentation of Staph aureus mitral valve endocarditis with anterior leaflet perforation, sepsis despite medical therapy, septic cerebral emboli (leading to focal neurological signs and acute encephalopathy (delirium)) and possible hematogenous lumbar vertebral discitis, mild anemia and acute renal impairment. Principles of diagnosis and management discussed. Lessons with respect to: subacute diagnosis (partial treatment), staph aureus ‘surgical disease’, lack of evidence of adverse outcome of early operation for septic cerebral emboli and evidence of improved outcome with early aggressive surgery. Challenges of management of complex multisystem disease patient discussed.
The edited presentation is here and papers regarding who and when to operate in infective endocarditis and timing of cardiac surgery in endocarditis.
10 April 2012 SC A case presentation of giant cell myocarditis: presentation with acute heart failure. The indications for biopsy, the prognosis (worse than lymphocytic myocarditis) and the registry data suggesting the value of immunopsuppression was discussed. The high mortality and the 25% recurrence with transplants was mentioned. The edited material will be posted when available.
17 April 2012 LOC A case presentation of elderly female with acute heart failure associated with atrial fibrillation with rapid ventriular response, evidence of left atrial enlargement and pulmonary edema. Echocardiography revealed severe mitral regurgitation secondary to P2 prolapse. Discussion regarding, diagnosis and management. The edited presentation is here.
24 April 2012 LAM A case presentation of a patient with non-cardiac chest pain who had incidental finding of right heart dilatation without pulmonary hypertension or obvious intracardiac shunt on transthoracic echocardiography. Cardiac catheterisation revealed normal epicardial coronary arteries and a significant right to left shunt at the atrial level. The left atrial was accessed. The impression was the passage was superior to typical foramen ovale. CT angiography revealed partial anomalous pulmonary vein drainage with multiple right upper lobe veins draining into the superior vena cava. There did not appear to be a sinus venosus atrial septal defect. Transesopshageal echocardiography was consistent with the CT. A general discussion of causes of right heart enlargement and partial anomalous pulmonary venous drainage was undertaken. An edited version will be posted when available.
8 May 2012 SC A case of 68 year old female with: (i) remote history of heart failure with LV systolic dysfunction treated with medical therapy associated with good clinical response and improvement in left ventricular ejection fraction (ii) evidence of lung disease with reduced FEV1/FVC but no increase in TLC and only small increase RV and moderate decrease in DLCO (iii) remote Hodgkins disease with previous mantle radiotherapy, presents with breathlessness. Echocardiography revealed: mild global LV systolic dysfunction without dilatation, aortic valve disease: at most moderate regurgitation and moderate (at most mitral regurgitation). The consensus opinion was the valve disease and LV dysfunction were insufficient explanation for the patient’s breathlessness. This was supported bu the BNP. The lung disease was thought to the most likely cause.
15 May 2012 LOC A new trial cardiac surgical referral form was introduced and discussed. The case presentation was a 29 year old male with recent reduction in exercise capacity with pre-excitation on surface ECG but no symptoms of arrhythmia. The patient had exercise ST depression and a small troponin elevation post exercise test. Coronary angiography revealed severe bifurcation LAD disease. Patient underwent complex bifurcational technique and expectant management with respect to pre-excitation.
22 May 2012 AL Case presentation: 48 year old male with fever, night sweats, progressive exertional dyspnea and intermittent hematuria and abnormal chest radiograph (bilateral alveolar infiltrates) and CT chest. Course complicated by fulminant respiratory failure requiring mechanical ventilation, hemodynamic instability (sinus tachycardia, relative hypotension associated with elevated CVP), abnormal troponin, severe segmental (but not typically vascular), renal impairment, eosinophilia. Susbsequently normal coronary arteries, and endomyocardial biopsy revealed eosinophilic myocarditis. Discussion of Churg Strauss, hypereosinophilic syndromes (including leukemoid/leukemic form), hypersensitivity syndromes and parasitic infection was undertaken.
29 May 2012 KL 1.Review of the Criteria Led Discharge Pilot: unanimously supported for continuation. 2. New Hospital phones introduced
19 June 2012 SC SC presented a patient who presented exertional presyncope, normal ECG and abnormal echocardiograph with increased LV wall thickness and systolic anterior motion of mitral valve and dynamic left ventricular outflow obstruction. No family history of cardiovascular disease. Labile hypertension. Initially thought to be hypertensive heart disease. Clinical progress stable mild symptoms on limited medical therapy with progressive changes ECG and echocardiography. Patient declined genetic testing. Clinical diagnosis: hypertrophic cardiomyopathy. Non-sustained VT (> 3 beats and > 120/minute) yields one sudden cardiac death risk factor. Cardiac MRI pending. General discussion of diagnosis HCM and risk factors for sudden cardiac death. The relevant material is available here.
3 July 2012 LAM 70 year old female presents with acute dyspnea, abnormal ECG (sinus tachycardia, T wave inversion V1 to V3 and III, aVf), small troponin elevation. Differential diagnosis discussed. Normal coronary angiography and abnormal echocardiography with normal LV size and systolic function but dilated dysfunctional RV. Abnormal CTPA confirming multiple pulmonary emboli.
10 July 2012 SC Case presentation of man presenting with subacute heart failure (R >L) in the context of chronic atrial fibrillation, abnormal echo suggesting cardiomyopathy, abnormal CTCA suggesting moderate obstructive CAD. Course complicated by sustained malignant ventricular arrhythmia requiring direct current countershock. Echo reveals markedly dilated RV with reduced RV systolic function, severe TR with normal RVSP, mild to moderate LV systolic dysfunction. No evidence intracardiac shunt. Cardiac catheterisation after treatment: branch disease. Normal pulmonary artery pressure. No shunt on oximetry. cMRI abnormal right heart but ARVC not excluded. No anomalous pulmonary venous drainage. Elevated ANA of uncertain significance: rheumatology opinion pending. AICD pending. General discussion of investigation right heart dilation without pulmonary arterial hypertension: left to right shunt, right sided valvular regurgitation, right ventricular dysfunction, ‘burnt out’ pulmonary vascular disease or cor pulmonale. Discussion of ARVC diagnostic criteria. Edited excerpt of presentation pending.
17 July 2012 LOC Elderly female with progressive exertional dyspnea, atrial fibrillation with left axis deviation and reduced R wave progression (QRS alternans), chronic moderate pericardial effusion with evidence of elevated RVSP. Diagnostic pericardiocentesis performed: hemorrhagic fluid. Abnormal hemodynamics post drainage. Concomitant 5.7 cm aortic aneurysm. General discussion of differential diagnosis, pericardial pathophysiology and ascending aortic aneurysm.
24 July 2012 AL Case presentation: 46 year male presented with syncope. Found to be in atrial fibrillation with rapid ventricular response. ECG confirmed AF and incomplete right bundle branch block. Chest radiograph shows increased cardiothoracic ratio (RB enlargement on lateral) and prominent pulmonary vasculature. Echo shows right ventricular and biatrial enlargement, normal RVSP and atrial septal defect. Transesophageal echocardiography showed large superior but ostium secundum atrial septal defect. Cardiac catheterisation discussed. Discussion of atrial septal defects anright heart catheterisation. Pitfalls as well as discussion regarding weighted average used to compute mixed venous oxygen.
31 July 2012 LAM 83 year old female with pleuritic chest pain, neutrophil luekocytosis, elevated CRP in the context of chronic lung disease. Final diagnosis: pyogenic Strep pneumoniae pericarditis in the context of chronic cor pulmonale complicated by recurrent effusion despite parenteral microbials requiring surgical pericardiectomy
7 August 2012 SC Elderly female with exertional dyspnea. Demonstrated difficulty of diagnosis of dyspnea and diagnosis of heart failure with preserved ejection fraction. Patient had remote history of rheumatic fever, borderline then abnormal BNP (confounding factors discussed: age, body mass, renal impairment), abnormal mitral valve (dense mitral annular calcification, abnormal leaflets, increased mean gradient assessed during anemia). Discussion regarding limitations and confounders of assessment severity of mitral stenosis: requires integration of clinical examination, ECG, echo and co-morbidities.
31 August 2012 AC PFO ASD Talk
25 September 2012 AC Case presentation: 46 year old male without traditional coronary heart disease risk factors presents with inferior STEMI without occlusive coronary artery disease. Course coomplicated by dvt, pte reinfarction. cMRI suggests two territories of infarction RCA and LADD of different age suggesting coronary embolism. Equivical bubble study and small patent foramen ovale. No procoagulant diathesis, no evidence malignancy (pulmonary nodules), no other sites embolism.
2 October 2012 SC Patient presentation with shock precipitated by complete heart block with rate 15 to 20/minute in the context of bone marrow transplantation with active graft versus host disease, acute heart failure with global LV systolic dysfunction in the context of acute septicaemia. Initially stabilised with external pacing then temporary transvenous pacing. Repeat echocardiography reveals normal LV systolic function (marked improvement compared with previously)
9 October 2012 AD Presentation regarding quality assurance in the echocardiography laboratory with a focus on the image interpretation of aortic regurgitation: interobserver variability and accuracy and trial of a hierarchical algorithm for grading severity. The presentation is here.
4 December 2012 AL Presentation of patient with cardiogenic shock secondary to ischemic mitral regurgitation and severe multivessel coronary artery disease management with stabilisation including balloon pump and emergency cardiac surgery. General disucssion of echocardiographic features of ischemic mitral regurgitation and surgical approaches and outcome. Presentation will be posted in due course.
22 January 2013 AL Case presentation of patient with spontaneous coronary dissection. The presentation is available here; (note: de-indentifited; powerpoint format; videos of angiography NOT linked). See also previous presentation here.
29 January 2013 Guest Presentation regarding bioprosthetic mitral and aortic valve replacements by an experienced cardiac surgeon.

2013 Education Sessions

Date Presenter Case Summary
12 February 2013 LOC Case presentation of 90 year old female presenting with symptomatic (presyncope and exertional dyspnea) bradyarrhythmia (2:1 AV block). General discussion of electrocardiographic interpretation and diagnosis and pacemaker therapy and pacemakers and device modes. Presentation will be posted in due course.
19 February 2013 SH Case presentation of stress cardiomyopathy in elderly Asian female precipitated by near drowning episode. Presentation with acute decompensated heart failure associated with atrial flutter with rapid ventricular response. Management of acute heart failure: management issues such as role of beta-blockers, inotropes, anticoagulation and current pathophsyiological concepts discussed. Presentation will be posted in due course.
22 February 2013 AD Presentation of introduction to cardiac magnetic resonance imaging (part 1). Presentation here.
26 February 2013 LAM Case presentation to motivate discussion of atrial fibrillation
5 March 2013 CC Case presentation: 54 year old female with metastatic breast cancer responding to chemotherapy with course complicated by Staph. aureus native aortic valve endocarditis. Illustration of rapid progression echocardiographically. Discussion of diagnosis and management and complex decision making for this specific patient. Presentation will be posted in due course.
19 March 2013 AB Case presentation of 59 year old male presenting with palpitations and presyncope with history of paroxysmal palpitations since teenage years. On presentation to regional centre: heart rate 260/min with SBP approx 110 mm Hg. ECG shows wide complex irregular tachycardia (RBBB morphology with LAD). Treated with DCCS. ECG in sinus rhythm: PR 120 ms with slurred upstroke lateral precordial lead. Lateral accessory pathway treated with RF ablation. Comprehensive discussion of Wolff Parkinson White ECG and syndrome. The presentation is available here.
26 March 2013 JA Case presentation and discussion of delirium in the CCU context
2 April 2013 IM Case presentation of 41 year old female pregnant with twins with symptomatic severe aortic stenosis with dysmorphic aortic valve. Detailed presentation of diagnosis, heart disease and pregnancy and aortic stenosis in pregnancy. Presentation is available here(deidentified; converted to pdf format; video non-functional).
11 June 2013 CC Case presentation of patient with post infarction ventricular septal defect. The presentatin is available here.
17 September 2013 KO Visiting Professor Keith Oldroyd presented “Advances in pharmacotherapy in ACS: implications for clinical practice”. This presentation is available here. Professor Oldroyd also provided insights into the PRAMI trial.
1 October 2013 AB Case presentation of patient presenting with syncope associated with right heart failure syndrome, periorbital edema, nephrotic syndrome and abnormal echocardiograph. The presentation is available here.
8 October 2013 Presentation of GLAGOV trial design: randomized clinical trial of PCSK9 antibody inhibitor: primary end-point change in percent atheroma volume on intravascular ultrasound.
15 October 2013 JA ESC 2013 update. Presentation is available here
29 October 2013 JT Case presentation of patient mechanical mitral valve thrombosis in the context of inadequate anticoagulation and hemodynamically significant GI bleeding complicated by embolic anterior ST elevation myocardial infarction, lower limb arterial embolus and progressive valve thrombosis. Review of mechanical mitral valve thrombosis presented. Presentation is here.
12 November 2013 CC Case presentation of the 34 year old male with hemodynamically stable sustained wide complex regular tachycardia: LBBB morphology (axis and precordial phase transition not typical for RVOT). Normal echoocardiography. Subtle RV wall motion abnormality: possible ARVC. Managed with beta-blocker and planned electrophysiology study including voltage mapping. General disussion of diagnostic and management approach to sustained wide complex tachycardia and limited discussion of ARVC. Presentation is available here
19 November 2013 SH Case presentation of 59 year old male with biventricular failure in the context of hereditary hemorrhagic telangiectasia. The patient had high output cardiac failure secondary to large hepatic arteriovenous fistulae with passive pulmonary arterial hypertension. Managed with liver transplantation. Discussion of high output cardiac failure and hereditary hemorrhagic telangiectasia.
26 November 2013 YS Case presentation of patient with tetralogy of Fallot with history of Blalock-Taussig shunt, corrective surgery then two pulmonary valve replacements (and RCA re-implantation) with progressive right heart dilation and right heart failure. Investigation revealed: patent foramen ovale and unroofed coronary sinus (->LA) leading to volume overload right heart; transesophageal echocardiography, CT chest, and cardiac catheterisation revealed 1.8:1 left to right shunt and left atrial angiography revealed two left to right shunts: one at level of patent foramen ovale and one via the coronary sinus.
3 December 2013 JT Case presentation of patient with abdominal aortic aneurysm who had abnormal myocardial perfusion imaging as part of preoperative cardiac risk stratification. Patient had concomitant thrombocytopenia (immune) and severe COAD General discussion of assessment and periprocedural management of thrombocytopenia and general discussion of assessment and optimization of COAD. Presentation is available here.
10 December 2013 MS Case presentation of pulmonary embolism complicating “below knee” DVT. Comprehensive presentation here
Date Presenter Case Summary
4 February 2014 CC Case presentation of 39 year old pregnant Torres Strait Islander with history of rheumatic heart disease (mixed mitral valve disease and moderate aortic regurgitation) presents with sepsis and atrial fibrillation with a rapid ventricular response complicated by progressive hemodynamic deterioration, atrial fibrillation with a rapid ventricular response, ischemic neurological event. Detailed discussion of a number of issues: amiodarone fetal effects (thyroid function, goitre, teratogenicity), other pharmacological interventions, other options: termination of pregnancy, balloon mitral valvuloplasty, mitral valve surgery- pros and cons for specific patient. A general discussion of mitral stenosis in pregnancy was undertaken. The presentation is available here.
18 February 2104 KL Case presentation of 24 year old female with symptoms consistent with progressive effort angina and abnormal myocardial perfusion study (extensive LCA reversible perfusion defect). The patient was found to have severe mid left main trunk stenosis and diffuse RCA disease and intravascular ultrasound consistent with atherosclerosis. The patient had type II diabetes melltus for 7 years and mild dyslipidemia.The presentation is available here
4 March 2014 SN Excellent presentation by Professor Stephen Nicholls as preparation and information resource re: GLAGOV trial. The presentation is available here.
18 March 2014 AL Case presentation of elderly vietnamese man with acute chest pain with borderline ECG changes. The patient had an acute aortic syndrome (intramural hematoma type) with initial involvement of the distal arch and descending arota and subsequent involvement of the ascending aorta. The patient was managed medically with monitoring and polypharmacological control of blood pressure. Discussion of diagnosism imaging and prognosis. The presentation is here.
25 March 2014 KL Case presentation of elderly female with congestive heart failure and patent ductus arteriosus. Discussion re: clinical features, imaging and non-invasive and invasive hemodynamic assessment. The presentation will be uploaded in due course.
8 April 2014 SP Case presentation of 45 year old Korean woman with angina and positive stress test at low workload. The patient had an ambiguous diffuse left main trunk stenosis with minimal lumen area around 4.9 mm^2. A discussion of assessment of ambiguous left main was presented. The patient’s underwent FFR and subsequently left main percutaneous coronary intervention (after cardiac surgical consultation advised against surgery). The patient’s course was complicated by vasospastic angina. Further discussion regarding vasospastic angina was undertaken. The issue of risk of sudden death was open. The presentation is available here.
15 April 2014 CC Case presentation of patient with ST elevation myocardial infarction in a regional centre. General discussion of management of STEMI: reperfusion, fibrinolysis, rescue PCI and adjunctive therapies. Presentation is available here.
22 April 2014>/td> KL Case presentation of 67 year old male with systemic congestion in context of nephrotic range proteinuria, type II diabetes mellitus, genetic hemochromatosis complicated by cirrhosis, portal hypertension, recurrent hepatocellular carcinomas. Found to have chronic at least moderate aortic regurgitation associated with LV dilation and systolic dysfunction. Mechanism of regurgitation: annuloectasia.
29 April 2014 AB Case presentation of 22 year old South African man with pleuritic chest pain, dyspnea, right pleural effusion and peripheral edema. Non-specifically abnormal ECG, abnormal chest radiograph with globular heart (increased cardiothoracic ratio) and right pleural effusion. Echocardiography: large pericardial effusion (fibrinous). Pericardiocentesis-exudate with low glucose and increased adenine deaminase. Susbsequent diagnosis of tuberculous pericarditis. Excellent general discussion re: diagnosis, investigation and management. The presentation is available here.
13 May 2014 SP Presentation of 76 year old male patient with exertional dyspnea and known moderate mitral regurgitation secondary to mitral valve prolapse who developed stress echocardiography induced stress cardiomyopathy. The patient had concomitant coronary heart disease that did not match the wall motion abnormality. The patient’s mitral regurgitation was reduced during the LV systolic dysfunction period. Mechanisms for this were discussed. A good general discussion of stress cardiomyopathy was discussed.
27 May 2014 AB Case presentation of 28 year old male who presented with recurrent syncope with high grade AV block.. Associated skin lesion including pre-tibial. Non-caseating granuloma consistent with sarcoidosis. Abnormal PET scan. Excellent discussion of cardiac sarcoidosis: diagnosis, management. Presentation is available here.
17 June 2014 JJA Professor Atherton presentation of highlights from the American College of Cardiology Meeting March 2014. Interventional and acute coronary syndrome topics covered. The presentation is available here
24 June 2014 AL Case presentation of 29 year old female with paroxysmal (frequent) accelerated idioventricular rhythm starting pre-pregnancy but increased frequency during pregnancy and associated with echocardiographic and MRI evidence of LV systolic dysfunction. Improvement with medical therapy and post poregnancy. Good general discussion. Presentation is available here.
1 July 2014 SH Case presentation of patient with congential absence of the pericardium. Imaging reviewed and general review of pericardial abnormalities.
8 July 2014 AB Case presentation of patient with WPW. Discussion regarding diagnosis and management.
Previously presented. Presentation here.
15 July 2014 CC Case presentation of 28 year old patient with history of upper limb deep venous thrombosis complicated by pulmonary thromboembolism. Underlying antiphospholipid syndrome. Variable anticoagulation. Patient presents with dyspnea,signs of right heart failure and pulmonary arterial hypertension. Instructive chest radiograph, echocardiographic, right heart catheterization and CT pulmonary angiography presented. Diagnosis: chronic thromboembolic pulmonary hypertension. General discussion of diagnosis and management: esp pulmonary thromboendarterectomy and use of pulmonary vasodilators. Presentation will be uploaded in due course.
29 July 2014 AL Case presentation of 57 year old Taiwanese male who presented with asystolic out of hospital cardiac arrest with history of Prinzmetal angina. Marked dynamic St shift and rhytmic instability in the cath lab assocated with marked mutlivessel coronary artery spasm. Excellent presentation of role of ICD in coronary artery spasm. Presentation is available here.
5 August 2014 SH Case presentation of 18 year old male referred for cardiac assessment of murmur found prior to ENT surgery. Patient had abnormal ECG, abnormal echocardiography: with increased wall thickness, lett atrial enlargment and abnormal diastology. The patient had a family history of rhythm disturbance and myopathy. The patient had an abnormal EMG and muscle biopsy revealed myofibrillar myopathy (same as mother) and gee testing revealed a new desmin mutation. Excellent discussion and presentation. Will be presented in due course.
12 August 2014 LC Case presentation of patient with ALCAPA (anomalous left coronary artery arising from pulmonary artery) with aneurysmal RCA. Presentation will be posted in due course.
19 August 2014 SH Case presentation of patient with chronic aortic regurgitation. Excellent discussion of chronic aortic regurgitation: clinical features and imaging findings. Presentation will be discussed in due course.
26 August 2014 Shortened meeting to allow farewell to long standing staff meeting. A discussion of the SERAPHIN trial lf macicentan in pulmonary arterial hypertension was undertaken. This was a high quality study for pulmonary arterial hypertenion (excluding portopulmonary and CTEPH) with beneficial effect on mortality as well composite mortality/morbidity. A discussion of the recent regulatory chnages was undertaken: PCWP criterion 15 mm Hg; abolition of exercise right heart catheterization.
29 August 2014 MD Light-hearted presentation related to Mathematics in cardiology: here.
9 September 2014 AL Case presentation of 29 year old with severe rheumatic aortic regurgitation and mitral regurgitation with significant LV systolic dysfunction who underwent aortic and mitral mechanical valve replacement. The patient presents with cardiogenic shock 3 months post operatively. The aetiology mitral valve thrombosis with severe acute obstruction. Treated with fibrinolysis with clinical and hemodynamic response. Course unfortunately complicated by unresuscitable cardiac arrest. Excellent presentation regarding frequency, diagnosis and management (surgery v lysis) was discussed. The presentation is available here.
30 September 2014 CZ Dr. Zappala provided an excellent summary of current therapeutic approaches to pulmonary arterial hypertension. The presentation is available here.
7 October 2014 CC Case presentation of 57 year old presentation with acute heart failure precipitated by atrial flutter in the context of levo-transposition of the great arteries (“congenitally corrected transposition of great arteries”, most common form SLL, not IDD). Good discussion and reviw of images. Presentation will be loaded in due course.
21 October 2014 AL Presentation of case of 79 year old man with history of ischemic stroke (imaging evidence consistent with multiple territory embolism) in the context of previous coronary artery bypass surgery. Echocardiography reveals a pendunculated apical mass. cMRI reveals perfusion and late gadolinium enhancement. Excellent discussion of fibroelastoma here.
4 November 2014 SH Patient with paradoxical embolism presenting as inferior ST elevation myocardial infarction and oxygen refractory hypoxemia. Excellent discussion of evidence base for shunt closure for patients with paradoxical embolsm and cryptogenic stroke.
11 November 2014 CC Patient presents with hemoptysis; Bronchoscopy revealed superficial lung cancer but generalized dilated mucosal veins. Patient had underlying mitral stenosis. Discussion of the patterns of broanchial venous circulation and relation to mitral stenosis. Correlated to PAWP but not PA or RA pressure. The presentation is available here

2015

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Case presentation of 86 year old female with fatal fulminant Staph lugdunensis aortic valve endocarditis. Discussion of endocardiitis, diagnosis and management and discussion of Staph lugdunensis. Presentation is available here.
10 February 2015 AL Case presentation of patient with metastatic Thurtle thyroid tumour with pericardial effusion. The presentation is available here.
17 February 2015 JS Presentation of JS of data from Impax CV as start of quality control processes.
24 February 2015 KK 79 year old female presents with atrial fibrillation with rapid ventricular response: palpitations without hemodynamic compromise, downsloping ST depression and monophasic troponin rise. Catheterization revealed severe LAD stenosis. Symptomatic bradyarrhythmia on beta-blocker therapy. Presentation is available here.
3 March 2015 SB Case presentation: 32 year old male presents with subacute decompensated heart failure. Patient had large left atrial myxoma. Presentation is available here.
10 March 2015 TO Case presentation of a 67 year old female with cardiac arrest on a plane resuscitated with automatic external defibrillator. Discussion of clinical features of case with provisional diagnosis of arrhythmogenic right ventricular cardiomyopathy. Good discussion of diagnostic and management approach to sudden cardiac death and arrhythmogenic right ventricular dysplasia, in particular diagnostic criteria. Presentation is available here.
25 March 2015 WP Presentation on cardiorenal syndrome: available here.
7 April 2015 KK Case presentation of cardiac manifestations of Graves disease. Presentation here.
21 April 2015 WP 35 year old male with ST elevation myocardial infarction in context polycythemia with course complicated by minimally symptomatic subacute stent thrombosis. General discussion of stent thrombosis and cardiac complications of polycythemia, diagnostic approach to polycythemia and CV therapeutic implications of polycythemia rubra vera. The presentation will be uploaded in due course.
28 April 2015 AL Case presentation of 56 year old with persistent atrial flutter/fibrillation, progressive segmental LV systolic dysfunction without vascular explanation, non-sustained VT, RV dysfunction with pulmonary arterial hypertension and significant LV diastolic dysfunction, mid wall septal late gadolinium enhancement on cardiac magnetic resonance imaging and CT calcific lymphadenopathy and parenchymal ground glass changes. Patient being worked up for cardiac sarcoidosis. Excellent discussion of sarcoidosis and cardiac sarcoid. Presentation will be uploaded in due course.
5 May 2015 CB Case presentation of 35 year old female with acute coronary syndrome with final diagnosis spontaneous coronary dissection. Detailed review presented. The presentation is available here.
9 June 2015 NA Case presentation of 71 year old female with blunt anterior chest trauma resulting in sternal fracture from motor vehicle accident. History suggests preceding loss of consciousness as precipitating factor. General discussion of diagnostic and management approach to blunt trauma including commotio cordis. The presentation is available here.
16 June 2015 AL Case presentation of 77 year old male with history of bioprosthetic aortic valve and paroxysmal atrial fibrillation with bladder tumour. Urological procedure complicated by enterococcus faecalis aortic valve prosthesis endocarditis: large vegetation/moderate compensated aortic regurgitation. The patient responded well to parenteral antimicrobial therapy. The patient was technically unsuitable for redo surgery. General discussion of diagnosis of infective endocarditis, esp prosthetic valve: diagnosis, indications for surgery. This will be uploaded in due course.
23 June 2015 KL Case presentation of male with with out of hospital cardiac arrest in the context of recent pacemaker implantation for symptomatic AV block. Evidence of pulmonary embolism on CTPA. Investigations: segmental LV and RV dysfunction; prominent hilar, anormal cardiac MRII showing subepicardial late gadolinium enhancement, medastinal adenopathy; aspiration consistent with granulomatous process and abnormal FDG scan. Diagnosis cardiac sarcoidosis: device upgraded to ICD; started on prednisone. Excellent presentation on cardiac sarcoidosis including new trial suggesting beneficial effect of prednisone on heart failure admissions and surrogate imaging end-points (as well as some evidence of early use in patients with AV block: reversibility.
The presentation is available here.
30 June 2015 CG Presentation by Professor Chris Gale on missed opportunities in STEMI and non STEMI care. The presentation was based on insights obtained from registries and linked large datasets. Issues such as the risk treatment paradox were highlighted. The presentation may be uploaded in due course.
7 July 2015 CB ECG Teaching Session. Cases presented include:
1. Type 1 Brugada syndrome 2. Multifocal atrial tachyacardia, right axis deviation and right ventricular hypertrophy 3. ECG changes related to intra-cranial catastrophe 4. Diagnosing STEMI in left bundle branch block 5. Pacemaker mediated tachycardia The presentation is available here.
14 July 2015 KY 49 year old male with recurrent noctural syncope. In hospital developed transient inferior ST elevation with bradycardia and hypotension. History of epicardial coronary spasm (Prinzmetal/variant angina). Discussion of Prinzmetal angina: diagnosis, prognosis and management. Presentation will be uploaded in due course.
28 July 2015 KL 25 year old male with atypical chest pain and history of syncope. Case became opportunity for discussion of ion channelopathies with emphasis on QT prolongation: diagnosis, genetics and management. The presentation will be uploaded in due course. The meeting was sponsored by Zoll and afforded opportunity for presentation WEARIT-II trial.
4 August 2015 KK ECG Review meeting. Presentation will be uploaded in due course.
1 September 2015 VF Case presentation of 24 year old female with narrow complex regular tachycardia in the context of previous electrophysiological ablative procedure. Discussion of the different types of SVT including AVNRT, AVRT and other types. Excellent discussion of electrophysiological study findings, ablation targets (anatomical targets) and ablation end-points for dual pathway physiology. The presentation is available here.
8 September 2015 SH Case presentation of patient with pericardial effusion in the context of metastatic breast cancer. Discussion of pathophysiology and diagnosis of cardiac tamponade.
15 September 2015 SB Case presentation of 71 female with dyspnea, hypoxemia and signs of right heart failure. Complex past medical history including prior coronary artery bypass grafting and aortic dissection. Excellent discussion of aortic dissection undertaken. The presentation is available here.
22 September 2015 KK 56 year old male presents with congestive heart failure with preserved LV systolic function and increased LV wall thickness. Ultimate diagnosis AL cardiac amyloid from plasma cell dyscrasia, Excellent discussion of cardiac amyloid. The presentation will be uploaded in due course.
29 September 2015 KL 61 female presents with palpitations and ultimately found to have AV canal defect. Review of imaging and general discussion of AV canal defects: anatomy, classification, diagnosis genetic and other associations and management. Presentation will be uploaded in due course.
6 October 2015 DM Case presentation of a 46 year old with acute coronary syndrome with ultimate diagnosis of spontaneous coronary dissection. Discussion of clinical features, diagnosis and management. Presentation will be uploaded in due course.
13 October 2015 DM Presentation on evaluation of patient presenting with syncope. Presentation will be uploaded in due course.
20 October 2015 AL Case presentation of chest pain with small troponin elevation in context off a patient with thrombotic thrombocytopenic purpura. Discussion of diagnosis and management of idiopathic HUS/TTP and ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) role in diagnosis. The presentation is available here.
25 October 2015 AL Presentations from Dr Antonio Lee:

27 October 2015 SB Case presentation of patient with chest pain and extertional dyspnea and abnormal CT. Diagnostic dilemma. Presentation is here.
3 November 2015 KL Female patient with collapse on domestic flight with evolving deep symmetrical T wave inversion associated with QT prolongation, significant monophasic troponin rise. Severe LV systolic dysfunction with apical ballooning suggestive of stress cardiomyopathy. Normal coronary arteries on angiography. Left ventriculography suggestive of apical mural thrombus confirmed on contrast echocardiography and cardiac MRI. Discussion of stress cardiomyopathy. Presentation will be discussed in due course.
10 November 2015 SB ECG cases. Presentation will be uploaded in due course.

17 November 2015 KK Case presentation of synchronous ischemic stroke and inferior STEMI. Patient treated with fibrinolytic therapy. Review of the evidence for fibrinolysis in ischemic stroke, evidence from fibrinolysis in STEMI. The presentation will be uploaded in due course.
1 December 2015 AL 47 year old male presents with out of hospital cardiac arrest: RBBB, LAD, QT prologation but JTc normal. Normal coronary arteries but severe segmental systolic dysfunction. Discussion of cardiac sarcoidosis. Presentation will be uploaded in due course.

8 December 2015 SH Case presentation of elderly woman with inferior ST elevation myocardial infarction secondary to multiple pulmonary emboli with paradoxical embolism.
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  1. September 4, 2012 at 10:11 am

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