Services - Multimedia and animations

PAD Overview Animation

A stereotypical PAD patient would have many of the risk factors (overweight male smoker with high LDL-C, hypertension and/or diabetes) and then experience leg pain. When we look into the leg, we see stenosis and mural thrombus formation. However, we know that even though the problem presents in the leg, it is actually indicative of widespread, diffuse disease, that actually originates in the heart. If left untreated, PAD can lead to plaque rupture, thrombus formation and complete occlusion, resulting in a myocardial infarction.

PAD Surgical Intervention Animation

Surgical intervention is necessary in some PAD patients with claudication. When we zoom into the artery, we see stenosis, in addition to some mural thrombus formation. When a stent is placed, the catheter is inserted to place the stent. The catheter is then withdrawn leaving the stent and a well dilated lumen. However, it is important to remember that stents are essentially a "quick fix", as if we look beyond the stent, we see that the underlying PAD is still present. PAD is a diffuse systemic disease, and it is essential to have long-term management the disease beyond the location of the event. Antiplatelet therapy (and warfarin anticoagulation in some cases) is recommended following lowe extremity revascularization.

PAD Pharmaceutical Interventions and Lifestyle Modifications Animation

If we zoom into the heart, we see the coronary artery endothelium in which platelets are aggregating on a lesion and are starting to release tissue factor, further promoting aggregation and thrombus formation. In order to prevent such activity, the recommended treatments for PAD patients include:

• ASA, which inhibits COX production of thromboxane, a vasoconstrictor and pro-aggregate, from arachidonic acid.
• Clopidogrel, which blocks ADP receptors on platelets, decreasing platelet activity and potential for aggregation.
• ACE Inhibitors, which inhibit conversion of Angiotensin 1 to Angiotensin II, a potent vasoconstrictor and pro-aggregate.
• Statins, which decrease LDL production while increasing LDL uptake.

All of these treatments reduce platelet activity and result in vascular benefits. After pharmacological treatment and lifestyle modifications, we see that our PAD patient has benefited from his treatment.

CRP Animation

This program consists of an excellent tutorial with accompanying animations that provide a comprehensive review of C-reactive protein and its role as a risk marker for cardiovascular disease. CRP, as a stable marker of inflammation, represents a surrogate marker of the underlying inflammatory process of atherosclerosis, as evidenced by a number of studies.

Ketolide Animation

This program provides an animated description of the role of ketolides for the empirical treatment of community-acquired pneumoniae. Some patients in Canada are infected with S. pneumoniae that is resistant to macrolides. The ketolides, such as telithromycin, are a new chemical family of antimicrobial agents. Ketolides may be a better choice for CAP patients in the empirical setting, including those with resistance.

Bradykinin Animation

This animation outlines the role that bradykinin plays in vascular protection, and the different effects of angiotensin receptor blockers (ARBs) and ACE inhibitors on bradykinin. Because ARBs do not affect ACE, they facilitate the breakdown of bradykinin. Conversely, ACE inhibitors prevent the breakdown of bradykinin, thereby preserving its benefits, which include: increased nitric oxide, improved fibrinolysis and ischemic preconditioning, inhibited platelet aggregation, and improved endothelial function and myocardial performance. Therefore, ARBs and ACE inhibitors may differ in their cardiovascular protection, as bradykinin is essential for proper coronary vascular function and largely responsible for atherosclerosis regression.