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Source: Cardiophile MD
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Total 1720 results found since Jan 2013.
Dip and plateau pattern of ventricular pressure tracing in constrictive pericarditis
Thickened and stiff pericardium in chronic constrictive pericarditis has poor compliance reducing the distension of cardiac chambers to a limited fixed total volume. Transmission of intrathoracic pressure to the pericardial cavity is also prevented by thickening of the pericardium [1]. Manifestation of compression occurs when the total cardiac volume reaches the pericardial volume in diastole. The severe restriction causes elevation of pulmonary and systemic venous pressure which becomes equal to diastolic pressures in all cardiac chambers. Relative change is more on the right sided chambers. Inspiratory fall in intratho...
Source: Cardiophile MD - August 31, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How can PDA mask a coarctation of aorta?
Coarctation of aorta may be missed when there is a large patent ductus arteriosus. This is because the ampulla of the ductus arteriosus is typically across the narrowed segment of aorta in coarctation of aorta. The wide ampulla in a way ameliorates the obstruction, making clinical detection of coarctation difficult. A good pulse can be felt in the lower limbs in such situations. There could be sudden deterioration with shock and mult-organ failure when such an associated patent ductus arteriosus is closed in an infant with an undetected coarctation of aorta. Detection of coarctation could also be difficult by transthoraci...
Source: Cardiophile MD - August 25, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Evaluation of Prosthetic Aortic Valve Obstruction
This discussion will focus beyond the basic clinical evaluation, ECG, chest X-ray and hematological workup. Hematological workup is important in aortic valve obstruction because of likelihood of associated hemolytic anemia and acquired von Willebrand Syndrome. Former is due to destruction of red blood cells across the narrowed aortic valve, and latter due to loss of the largest multimers of von Willebrand factor. High shear stress across the narrowed aortic valve exposes a region of the von Willebrand factor which is susceptible to a specific von Willebrand protease. This can lead on to gastrointestinal angiodysplasia (He...
Source: Cardiophile MD - August 9, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Poor Long Term Outcome With Subsequent Pregnancies After Peripartum Cardiomyopathy
This study was from a single centre where mortality in women with peripartum cardiomyopathy was higher than in other studies from the United Studies. Most of the patients were African American and of low socioeconomic status. Earlier studies have clearly demonstrated a different phenotypic presentation and outcome in African American women with peripartum cardiomyopathy compared to non-African American women. African American women had been shown to be diagnosed later, present lower LVEF, larger LV volume and more severe heart failure symptoms. The rate of recovery was lower and time for recovery markedly longer in that pa...
Source: Cardiophile MD - June 28, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
High-Frequency Low-Tidal-Volume Ventilation During Atrial Fibrillation Ablation Improves Long Term Outcome
Catheter ablation for pulmonary vein isolation is an important modality of treatment for paroxysmal atrial fibrillation. It is also useful for persistent atrial fibrillation, though a little less. Importance of maintaining a stable contact force of the catheter during radiofrequency ablation cannot overstressed as it contributes to lesion size and achieving transmural lesion. Both these are important in reducing re-connection of pulmonary veins, an important cause for recurrent atrial fibrillation after catheter ablation. General anaesthesia during procedure reduces the rate of pulmonary vein reconnection and hence recurr...
Source: Cardiophile MD - June 24, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Ultrahigh-Resolution Photon-counting CT Useful Prior to Transcatheter Aortic Valve Replacement
Assessment of coronary anatomy prior to Transcatheter Aortic Valve Replacement has great prognostic significance. Invasive coronary angiography is done prior to TAVR though CT coronary angiography has a role in ruling out coronary artery disease in those with low or intermediate pretest probabilities. Accurate interpretation of coronary arteries in those planned for TAVR has challenges because of high occurrence of abnormal heart rhythm, contraindications for beta blockers and nitroglycerine administraton.
Still important is the blooming artifacts on CT coronary angiography in those with coronary stents or severe calcific...
Source: Cardiophile MD - June 21, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Heritable Component for Bicuspid Aortic Valve and Thoracic Aortic Disease?
Is there a heritable component for bicuspid aortic valve disease and thoracic aortic disease including aneurysm and dissection? So it seems, from a study published in Circulation from the University of Utah School of Medicine [1]. The study included a huge database of 3, 812, 588 unique individuals! From the database they identified probands with a diagnosis of bicuspid aortic valve, thoracic aortic aneurysm or thoracic aortic dissection. Age and sex matched controls in the ratio 10:1 were identified for each proband. They also identified first degree relatives, second degree relatives and first cousins of the p...
Source: Cardiophile MD - June 18, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Ductus Dependent Circulation
Ductus dependent circulation is one in which a patent ductus arteriosus is useful in maintaining the circulation after birth. It is important to rule out such conditions before any PDA closure is planned. PDA dependent circulations can be PDA dependent pulmonary circulation, PDA dependent systemic circulation and PDA dependent mixed circulation. The first group includes pulmonary atresia, tricuspid atresia and tetralogy of Fallot with pulmonary atresia. In those cases, post natal physiological constriction of ductus arteriosus can cause severe hypoxemia, cyanosis and even death. In these cases, there is severe restriction...
Source: Cardiophile MD - June 13, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain
Stress cardiovascular magnetic resonance imaging is not as commonly used for evaluation of persons with stable chest pain as other modalities of non-invasive evaluation. Ricci and colleageus have reported a systematic review and meta-analysis on this aspect in JAMA Cardiology [1]. They evaluated 33 diagnostic studies including 7814 persons and 31 prognostic studies including 67,080 persons. The included studies were between 2002 and 2021.
The authors concluded that stress CMR had high diagnostic accuracy and had robust prognostication, especially when 3 Tesla MRI scanners were used. Myocardial ischemia and late gadoliniu...
Source: Cardiophile MD - June 12, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Fontan Paradox?
The term Fontan Paradox was coined by Marc de Leval in 2005 as paradox seen in Fontan circulation with caval hypertension, mainly in the splanchnic region and relative pulmonary arterial hypotension [1,2]. According to him, in a normal biventricular circulation, the mean caval pressures are less than 10 mm Hg and the mean pulmonary arterial pressure is at least 15 mm Hg to keep the pulmonary vasculature patent. He further suggested that a mechanical device capable of producing a step down in pressure energy of 5 mm Hg in the inferior vena cava and producing a step up of 5 mm Hg in the pulmonary arteries could potentially ...
Source: Cardiophile MD - June 9, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
COAPT Trial of Transcatheter Mitral Valve Repair in Patients with Heart Failure
Patients with heart failure and left ventricular dilatation may have secondary or functional mitral regurgitation. This is due to alteration of the left ventricular geometry producing changes in the functioning of papillary muscles and chordae tendineae and poor coaptation of the mitral leaflets. Secondary mitral regurgitation causes volume overloading of the left ventricle and is associated with reduced survival, increased hospitalization rates and decreased quality of life [1, 2]. Secondary mitral regurgitation can be reduced by guideline directed medical therapy and cardiac resynchronization therapy. This will also pro...
Source: Cardiophile MD - June 5, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Structural Heart Disease Interventions Source Type: blogs
Myocardial Insulin Resistance
Myocardial insulin resistance is said to occur in about 60% of patients with type 2 diabestes mellitus and is associated with higher cardiovascular risk compared to those with insulin sensitive myocardium [1]. It is known that systemic insulin resistance is an independent risk factor for heart failure and cardiovascular death [2]. Myocardial insulin resistance occuring along with systemic insulin resistance is characterized by ineffecient energy metabolism and contributes to post ischemic heart failure. Myocardial insulin resistance can also be caused by myocardial hypertrophy, independent of systemic insulin resist...
Source: Cardiophile MD - June 3, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can Febuxostat Protect From Contrast Induced AKI?
Contrast induced acute kidney injury is an important concern in patients undergoing percutaneous coronary interventions due the larger volume of contrast needed in comparison to diagnostic studies. It is more likely in patients undergoing primary angioplasty for acute myocardial infarction because of greater hemodynamic instability and lack of chance for protective measures like pre-procedure hydration.
A randomized controlled trial evaluated 120 patients with stage 3 chronic kidney disease who underwent PCI for acute coronary syndrome [1]. 60 patients received Febuxostat in addition to intravenous hydration and N-acetylc...
Source: Cardiophile MD - June 2, 2023 Category: Cardiology Authors: Johnson Francis Tags: Coronary Interventions General Cardiology Source Type: blogs
Causes of heart attack and cardiac arrest in teenagers
A heart attack occurs when blood flow to a part of the heart muscle stops. Heart attacks in teenagers can be caused by rare genetic diseases, such as familial homozygous hypercholesterolemia, which increases blood cholesterol levels, and some rare diseases that affect the blood vessels of the heart, such as Kawasaki disease.
Cardiac arrest means the heart stops working completely. A heart attack can lead to cardiac arrest. Inherited diseases like Congenital long QT syndrome and Brugada syndrome that cause cardiac arrhythmias and can also cause cardiac arrest in adolescents.
Source: Cardiophile MD - June 1, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Clinical Examination of Cardiovascular System For Medical Students
Discussion on blood pressure is not included here as a separate topic is dedicated to it.
Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate.
Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may...
Source: Cardiophile MD - May 30, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
