Should we worry about carbon footprint of medical interventions?
I had never thought of the carbon footprint of medical interventions till I read the perspective article “Carbon-Footprint Analyses in RCTs – Toward Sustainable Clinical Practice” in the New England Journal of Medicine just now [1]. As an extreme example, they have cited the difference in carbon footprint between two anesthetic gases sevoflurane and desflurane which have been shown to have similar effectiveness in many randomized controlled trials. They mention that while 1 kg of sevoflurane has a global warming potential equal to emission of 130 kg of carbondioxide, desflurane has a potential equivalent...
Source: Cardiophile MD - May 16, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Aficamten – One More Cardiac Myosin Inhibitor for HOCM
Mavacamten is now approved for treatment of symptomatic hypertrophic obstructive cardiomyopathy and endorsed by mult-society guidelines. Now we have Aficamten, next in class cardiac myosin inhibitor for HOCM. Phase 2 Study of Aficamten in Patients With Obstructive Hypertrophic Cardiomyopathy was published in 2023, with 28 patients on aficamten 13 on placebo. There was substanital reduction in LVOT gradients and most patients experienced improvement in biomarkers and symptoms [1]. Now a phase 3 trial (SEQUOIA-HCM) of aficamten has been published online in NEJM ahead of print [2]. The study had 142 patients in aficamten gr...
Source: Cardiophile MD - May 15, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Dual-Chamber Leadless Pacemaker
Lead of a pacemaker is often called as its Achilles Heel as most of the problems in a pacing system occur with the leads. Hence the quest for leadless pacemakers which are implanted within the heart through a delivery system. Single chamber leadless pacemakers have been around for quite some time. A new dual-chamber leadless pacing system has been tested successfully recently. It consists of two separate atrial and ventricular devices which communicate to maintain synchronous atrioventricular pacing and sensing. The first in-human evaluation of the new dual-chamber leadless pacemaker system showed reliable electrical perfo...
Source: Cardiophile MD - May 13, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
High Prevalence of Cardiovascular Disease and Risk Factors Among Former National Football League Players
I expected that former football players, especially at the national level would continue some form of physical activity and remain relatively fit during the rest of their life as they have been well trained. But results of an analysis of HUDDLE study tells us differently [1]. Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms was aimed to raise awareness and estimate the prevalence of cardiovascular disease and associated risk factors among members of the United States, National Football League Alumni Association and their family members through education and screening events. HUDDLE was a mul...
Source: Cardiophile MD - May 12, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
2024 ACC/AHA/Multisociety Guidelines for Management of Hypertrophic Cardiomyopathy Released
2024 ACC/AHA/Multisociety Guidelines for Management of Hypertrophic Cardiomyopathy is now available online with free access at JACC website. Both PDF and HTML versions are available and you can choose either depending on your reading preference. The PDF version runs into 82 pages and is a 4.49 MB download. As it is a ‘Just Accepted’ paper which is yet to become part of a full issue, page numbers are not for citation. I was quite happy to see the name of my friend Seshadri Balaji representing Heart Rhythm Society among the writing committee members. Prof. Balaji is originally from Tamil Nadu, South India.
Those...
Source: Cardiophile MD - May 8, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Transesophageal echocardiogram
Echocardiogram is an image of the heart using ultrasound. An ultrasound beam is transmitted into the body using a device known as transducer. The echo received from the body is processed by the computer in the machine to give an image of the heart.
Transesophageal echocardiogram or TEE test, is obtained by introducing a special type of transducer, also called a TEE probe, through the throat into the food pipe (esophagus) and stomach. Usual echocardiogram is obtained by placing the transducer or probe on the chest.
Lungs may overlap the heart intermittently while imaging the heart from the chest wall. This is because the lu...
Source: Cardiophile MD - May 7, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Basic Principles of Colour Doppler Echocardiography
Usual colour Doppler echocardiogram is superimposition of colour Doppler images on a two dimensional echocardiogram. Colour M-Mode is superimposition of colour Doppler images on an M-Mode echocardiogram. The principle of Doppler is that the frequency of sound wave coming from an object which is moving towards the ultrasound probe increases while that from an object moving away from the probe decreases. It is similar to the difference in the sound of a train whistle, which is different when the train is moving towards you than when it is moving away from you. In Doppler echocardiography, the target is moving red blood cells...
Source: Cardiophile MD - May 4, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiac Monitors
Cardiac monitors are devices with displays to show ECG, heart rate and other parameters on a continuous basis, usually used in the intensive care unit or operation theatre. Earlier cardiac monitors had just ECG and heart rate displays.
Current multi parameter monitors have invasive and non-invasive blood pressure, respiration, pulse oximetry, pacemaker sensing and various other monitoring possibilities. It can give out alarms if heart rate or any other parameter is beyond the set limits.
Sometimes the number of alarms is so many that ICU staff may develop “alarm fatigue” and stop responding to alarms. Hence alarm limit...
Source: Cardiophile MD - May 3, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is athlete ’s heart?
Athlete’s heart denotes structural, functional, and electrical remodeling seen in trained athletes. It is a physiological adaptation helping athletes perform physical tasks better than non-athletes. Though most of the findings in athlete’s heart are related to the left ventricle, changes do occur in the right ventricle as well.
During aerobic exercise which is isotonic, the heart rate and stroke volume increases. Systemic vascular resistance falls, but slight to moderate increase in blood pressure can occur due to the increased cardiac output.
As the cardiac output increases, it is a mostly a volume overload situation ...
Source: Cardiophile MD - May 2, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Should you measure blood pressure in both arms?
Guidelines on hypertension (high blood pressure) generally recommend measurement of blood pressure in both arms in the initial visit. They also suggest that the arm with higher blood pressure recording should be used to record blood pressure in subsequent visits. It is often mentioned that there is a small difference in the blood pressure between the arms and usually it is the right arm blood pressure which is higher.
Blood vessels to both arms arise from the largest blood vessel in the body supplying oxygenated blood known as aorta. The origin of the blood vessel to the right arm is in line with initial part of the aorta....
Source: Cardiophile MD - May 1, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
CRT-P and CRT-D
CRT stands for cardiac resynchronization therapy. CRT is used in heart failure with reduced ejection fraction. According to the Universal Definition and Classification of Heart Failure, heart failure with reduced ejection fraction has left ventricular ejection fraction of 40% or less. CRT is a type of pacemaker in which three chambers of the heart are paced, right atrium, right ventricle and left ventricle.
This picture illustrates what reduced ejection fraction means. Ejection fraction is the fraction of end diastolic volume which is pumped out from the left ventricle during systole. Normal ejection fraction is around 60 ...
Source: Cardiophile MD - May 1, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is a genetic disorder with a guarded prognosis which occurs in about 1:500 individuals.
It is an autosomal dominant disorder with variable penetrance with either a defect in sarcomeric protein genes which encode for myosin heavy chain, actin or tropomyosin or due to abnormal myocardial Ca++ kinetics which increase intracellular Ca++, causing hypertrophy and cellular disarray.
Echocardiography is the sheet anchor of diagnosis of HCM and other modalities are complementary.
MYH7 mutation in the gene which encodes for beta myosin heavy chain, located on chromosome 14 is found in about 15-25% of case...
Source: Cardiophile MD - May 1, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Coronary Diagnostic Catheters
Diagnostic coronary angiography is most often undertaken either through the femoral route or radial route. Rarely brachial or axillary access may be resorted to if the popular radial or femoral routes are not feasible. Femoral access may be preferred in an emergency when quick arterial access is needed. It is also used when more devices have to be introduced, but seldom the case for diagnostic coronary angiography. The most popular catheter for femoral route is Judkins catheter. Judkins catheter comes in left coronary and right coronary curves. They have a primary curve and a secondary curve. Primary curve engages the coro...
Source: Cardiophile MD - April 30, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How Does Exercise Prevent Heart Disease?
Dr. Paul Dudley White, the famous physician who has taught many a luminary in the field of cardiology once wrote that heart disease before eighty is our fault and not God’s will or nature’s will.
This means that he recognized long back, the role of life-style modification in preventing heart disease. Exercise in a regular pattern is one of the important life style modifications which everyone can adopt to prevent or delay cardiovascular disease. Exercise helps in various ways for prevention of cardiovascular disease. In those with established cardiovascular disease, graded exercise programs can promote the formation of...
Source: Cardiophile MD - April 30, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Should you take medications for high blood pressure lifelong?
The answer depends on what caused your high blood pressure. If it is a reversible cause which can be removed, then of course medications can be stopped.
But if a reversible cause has not been found, you should be cautious about stopping medications.
What are the reversible causes of high blood pressure? A transient drop in kidney function due to some illness (acute kidney injury) can raise the blood pressure. But when the kidney problem settles, blood pressure normalizes, and it may never recur. In this situation blood pressure medication can certainly be stopped.
There are certain rare tumours which secrete hormones which...
Source: Cardiophile MD - April 29, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
