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What is the effect of Atrial fibrillation on blood pressure ?
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing  RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In dysfunctional ventricles or in acute AF* this variation in systolic  BP can be significant. Also realize, If the preload is changing every beat, there is a consider...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs

Laser atherectomy
Laser atherectomy is a novel technique useful in in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions [1]. An important advantage of excimer laser atherectomy over other atherectomy devices is delivery on a standard 0.014-inch guidewire [2]. The technique can be mastered after a short period of training. Major limitation is the presence of heavy calcification, which requires rotational atherectomy for clearance. But when there is inability to pass a rota wire, laser may be useful in creating an upstream channel to permit rota wire passage. Laser device works by producing mon...
Source: Cardiophile MD - September 11, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Photoacoustic Carbon Nanotubes Reveal Dangerous Atherosclerotic Plaques
Researchers at Michigan State University have developed a system that allows the imaging and identification of inflamed atherosclerotic plaques, which are considered to be at risk of rupture. Their system involves administering carbon nanotubes that ...
Source: Medgadget - August 18, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Nanomedicine Radiology Vascular Surgery Source Type: blogs

We Need to Open Up the AI Black Box
To convince physicians and nurses that deep learning algorithms are worth using in everyday practice, developers need to explain how they work in plain clinical English.Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform, and John Halamka, M.D., president, Mayo Clinic Platform, wrote this article.AI ’s so-called black box refers to the fact that much of the underlying technology behind machine learning-enhanced algorithms isprobability/statistics without a human readable explanation.Oftentimes that ’s the case because the advanced math or the data science behind the algorithms is t...
Source: Life as a Healthcare CIO - August 17, 2021 Category: Information Technology Source Type: blogs

Sensing Glove to Aid in Stroke Recovery
Researchers at MIT created a sensing glove that can detect small pressuref changes along its surface when a wearer grasps something. The glove is threaded with tiny pressure sensors, which are studded with micropillars that create changes in an elect...
Source: Medgadget - August 10, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Materials Neurology Rehab Source Type: blogs

Ultrasound Patch Monitors Blood Flow
Researchers at the University of California San Diego created an ultrasound patch that can measure blood flow in vessels as deep as 14 cm within the body. The stretchy patch can be applied to the skin and may help clinicians to monitor and diagnose v...
Source: Medgadget - July 28, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Diagnostics Materials Radiology Thoracic Surgery Vascular Surgery Source Type: blogs

Z- score classification of coronary aneurysms in Kawasaki disease
Z-score is the standard deviation from coronary artery internal lumen diameter normalized for body surface area. AHA classification of coronary artery aneurysms based on Z-score is as follows [1]: 1. No involvement with Z score less than 2 always. 2. Dilatation only with Z scores from 2 to less than 2.5 or a decrease in Z score of 1 or more during follow up if it was less than 2 initially. 3. Small aneurysm with Z score of more than 2.5, but less than 5. 4. Medium aneurysm with Z score 5 or more, but less than 5 and absolute dimension less than 8 mm. 5. Large or giant aneurysm with Z score 10 or more or absolute dimension...
Source: Cardiophile MD - July 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

P2-CHA2DS2-VASc Score
P2-CHA2DS2-VASc score adds additional two points to the CHA2DS2-VASc score for an abnormal P wave axis to predict risk of stroke in atrial fibrillation (AF) [1]. The seminal study was an attempt to identify utility of P wave indices in sinus rhythm to predict the risk of stroke over and above the existing CHA2DS2-VASc score. P wave indices evaluated were prolonged P wave duration, abnormal P wave axis, advanced interatrial block and abnormal P wave terminal force in lead V1. They found that abnormal P wave axis which is an ECG correlate of left atrial abnormality improves the prediction of ischemic stroke. They concluded ...
Source: Cardiophile MD - July 21, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Fight Aging! Newsletter, July 19th 2021
In this study, we developed the first epigenetic clock for domesticated sheep (Ovis aries), which can predict chronological age with a median absolute error of 5.1 months. We have discovered that castrated male sheep have a decelerated aging rate compared to intact males, mediated at least in part by the removal of androgens. Furthermore, we identified several androgen-sensitive CpG dinucleotides that become progressively hypomethylated with age in intact males, but remain stable in castrated males and females. Comparable sex-specific methylation differences in MKLN1 also exist in bat skin and a range of mouse tissu...
Source: Fight Aging! - July 18, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Treatment of infective endocarditis
Discussion of whole list of options of antimicrobials for different varieties of endocarditis is quite a large topic. This discussion is only a broad outline of the antimicrobial treatment of infective endocarditis, meant mainly for exam purpose rather than actual clinical treatment. References to more detailed guidelines have been provided for those who wish to learn more. Inoculum Effect High microbial density as in vegetations cause less antimicrobial activity of some antimicrobial agents. This is known as inoculum effect and has been documented with β-lactams and glycopeptides but not linezolid, in the treatment of St...
Source: Cardiophile MD - July 16, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Aortic stenosis – TAVR (TAVI) vs SAVR
Discussion so far is based on ACC/AHA guidelines, 2020 [1]. ESC/EACTS guidelines for management of valvular heart disease were published in 2017 [2]. The guideline mentions that data on TAVI are limited for patients below 75 years and for low surgical risk patients. Hence SAVR was preferred in those patients. On this aspect, the more recent ACC/AHA guidelines incorporate more recent evidence. In ESC/EACTS guidelines, SAVR is preferred if STS/EuroSCORE II is less than 4% and TAVI if it is more than or equal to 4%. TAVI is preferred in those with severe comorbidity, previous cardiac surgery, frailty, and restricted mobility....
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Cardiac Surgery Structural Heart Disease Interventions Source Type: blogs

Cardiology MCQs
Which of the following is an innocent murmur? Gibson’s murmur Roger’s murmur Still’s murmur Dock’s murmur Correct answer: 3. Still’s murmur Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmur heard in the lower left sternal area. It is best heard with the bell of the stethoscope. Still’s murmur is a mid systolic murmur, loudest in supine position and diminishes in intensity on sitting and standing as venous return decreases [Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689]. Gibson’s murmur is the train-in-tunnel murmur or ma...
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Ischemic preconditioning
The concept of ischemic preconditioning is that multiple short episodes of ischemia can protect the heart from a later sustained ischemia later [1]. In an experimental study, 4 episodes of 5 minutes each, separated by 5 minutes of reperfusion followed by 40 minutes of occlusion showed 75% reduction in infarct size compared to controls. But this benefit was not there when the final occlusion time was 3 hours. Authors suggested that multiple pre-infarction anginal episodes may have a similar effect on limiting infarct size if myocardial infarction occurs subsequently. Others have suggested that similar mechanism might opera...
Source: Cardiophile MD - July 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Role of adenosine in atrial fibrillation
First and foremost, it must be remembered that adenosine is not to be given in atrial fibrillation if there is an atrioventricular bypass tract (ventricular pre-excitation) like Wolff-Parkinson-White syndrome. This is because it slows conduction through the atrioventricular (AV) node, but does not affect the accessory pathway. Secondly, adenosine can rarely induce atrial fibrillation and very rarely ventricular fibrillation. Adenosine guided pulmonary vein ablation has been studied as adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction. Identifying dormant conduction will guide...
Source: Cardiophile MD - June 19, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

HOST-EXAM trial
This study is definitely hypothesis generating and calls for a multi national, double blind comparison on a larger scale to get a better conclusion on long term antiplatelet monotherapy after PCI with DES.  AUGUSTUS trial A somewhat similar disadvantage for aspirin was suggested in the AUGUSTUS trial among patients with atrial fibrillation and recent ACS or PCI [2]. Adding apixaban to P2Y12 inhibitor resulted in lower bleeding compared with vitamin K antagonist and a lower rate of death or rehospitalization. Addition of aspirin resulted in greater bleeding without any difference in efficacy. 92.6% of the patients...
Source: Cardiophile MD - June 15, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs