TGA like physiology
– cyanotic heart disease with high pulmonary blood flow
Following congenital heart diseases have cyanosis with high pulmonary blood flood flow (TGA like physiology or transposition like physiology):
Dextro transposition of great arteries (D- TGA) with ventricular septal defect (VSD) and no pulmonary stenosis (PS)
Double outlet right ventricle (DORV) with VSD and no PS
Tricuspid atresia with VSD and no PS
TGA like physiologies can present with cyanosis and heart failure in very early life due to increased pulmonary blood flow as there is no pulmonary stenosis to restrict the pulmonary blood flow. D-TGA with VSD and no P...
Source: Cardiophile MD - August 4, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Arterial switch operation cyanotic heart disease cyanotic heart disease with high pulmonary blood flow d-TGA dextro transposition of great arteries DORV Jatene's operation PS Pulmonary stenosis TGA like physiology Source Type: blogs
Fallot like physiology
– cyanotic heart disease with low pulmonary blood flow:
Basic components of this physiology are a large ventricular septal defect (or single ventricle) and severe pulmonary stenosis so that there is right to left shunt across the VSD and low pulmonary blood flow due to the pulmonary stenosis. They can develop hypercyanotic spells and cerebrovascular accidents while they seldom go in for heart failure, unlike the congenital cyanotic heart diseases with increased pulmonary blood flow. Chest X-ray shows pulmonary oligemia and cardiac size is seldom enlarged. The conditions included in this physiology are:
Tetralogy of Fall...
Source: Cardiophile MD - August 4, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology CCHD with low pulmonary blood flow cyanotic congenital heart disease with low pulmonary blood flow cyanotic heart disease with low pulmonary blood flow Fallot like physiology Gasul phenomenon Gasul variant Tetralogy of Fal Source Type: blogs
Can a coronary artery fill from the right ventricular injection?
It can occur if the aorta is arising from the right ventricle or when there is a large ventricular septal defect. Another possibility is retrograde filling through the sinusoids in coronary cameral fistula from a coronary artery to the right ventricle. In this case the dye will be seen filling the sinusoids first and then the coronary branches followed by the main coronary artery. Prominent right ventricular sinusoids are seen in pulmonary atresia with intact ventricular septum. (Source: Cardiophile MD)
Source: Cardiophile MD - July 29, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Coronary cameral fistula large ventricular septal defect Prominent right ventricular sinusoids pulmonary atresia with intact ventricular septum right ventricular injection Source Type: blogs
What can cause an obligatory right to left shunt at the atrial level?
In tricuspid atresia, there is an obligatory right to left shunt at the atrial level. Similar situation occurs in TAPVC as well. (Source: Cardiophile MD)
Source: Cardiophile MD - July 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology obligatory right to left shunt at the atrial level TAPVC tricuspid atresia Source Type: blogs
An unexpected Avatar of Potts surgery !
Many decades ago Potts shunt (Central Aortic -PA shunt)was used to increase pulmonary blood flow for severe RVOT obstruction mostly for TOF and tricuspid atresia .With the advent of ICR and Fontan role for central aorti shunts waned.
Now, read this
Chronic ,refractory pulmonary hypertension of any cause has dismal outcome.In patients with severe PAH many patients reach supra-systemic pressures . RV a volume handling chamber faces a uphill task of overcoming huge RV after load. As cardiac physicians , we struggle to perfuse the lungs in such situations.
The only option seems to be lung trans...
Source: Dr.S.Venkatesan MD - February 18, 2014 Category: Cardiology Authors: dr s venkatesan Tags: cardiac surgery cardiology -Therapeutics cardiology congenital heart disese cardiology innovation Cardiology Innovations pulmonary hypertension a new avatar for potts shunt percutaneous potts surgery for severe pah Potts shunt for eisenmen Source Type: blogs
Top stories in health and medicine, November 7, 2013
From MedPage Today:
Supplements Blamed for Liver Toxicity. The rate of liver damage caused by dietary and herbal supplements — especially those used for bodybuilding — appears to be on the rise.
Bilingual? Dementia May Be Delayed. Compared with people who can speak only one language, those who were familiar with multiple languages had a later onset of dementia — even if they were illiterate and lacking formal education.
Studies ‘Validate’ CDC HCV Testing Advice. Thousands of people in the U.S. — including an estimated 50,000 veterans — are infected with the hepatitis C virus (HCV...
Source: Kevin, M.D. - Medical Weblog - November 7, 2013 Category: Family Physicians Tags: News GI Neurology Source Type: blogs
This ECG troubled us for a while !
In one of my classes , this ECG was presented . Controversy erupted.It was about the basics .
What is the QRS axis of this ECG ?
Not surprisingly there were handful of answers .
North west Axis
Indeterminate QRS
+150
+180
0 degrees
Extreme Right axis
Which is correct ? My guess is , it should be closer to + 180 . Lead 2 is equiphasic and perpendicular lead is negative limb of AVL ie + 150 .If you plot Lead 1 and AVF in graph and calculate we get + 135 . (In the strict sense , we are not supposed to take one standard lead and an augmented lead for plotting ). Finally, the strongest argumen...
Source: Dr.S.Venkatesan MD - October 20, 2013 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -ECG Infrequently asked questions in cardiology (iFAQs) ecg in pulmoanry atresia extreme left and right axis indeterminate qrs axis north west axis what is north west qrs axis ? Source Type: blogs
Ghost in the Brain- CT Image Mimicking a Ghost
There is a image case in NEJM which has a cerebellar haemorrhage , extending into midbrain and third ventricle and we radiologists are so famous for imagining and giving appearances names to pathologies as per their similarity to common things, and aptly this has been called as "ghost in the brain"
Check the Link.
NEJM-Ghost in The Brain
Another Ghost Sign in Radiology is:
Gallbladder ghost triad (seen in Biliary Atresia) on ultrasound studies is a combination of :
GB length less than 19 mm
irregular or lobular contour
lack of smooth/complete echogenic mucosal lining with an indistinct wal...
Source: Sumer's Radiology Site - September 3, 2013 Category: Radiologists Authors: Sumer Sethi Source Type: blogs
Tricuspid atresia – ECG
Tricuspid atresia – ECG
Click on the image for a larger view
Right atrial overload is manifest as tall P waves in lead II and left ventricular hypertrophy with strain pattern is seen in lateral leads with tall R waves, ST segment depression and T wave inversion. The axis is leftward with predominantly negative QRS in leads III and aVF. The biphasic P wave in V1 with sharp atrial intrinsicoid deflection (the sharp downward deflection from the peak of the P wave to the trough of the P wave) is a pseudo left atrial overload pattern, seen in right atrial overload. In true left atrial overload the atrial intrinscoid defle...
Source: Cardiophile MD - July 26, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG Source Type: blogs
Cardiology MCQ Online 4
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Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG Echocardiography Source Type: blogs
Cardiology MCQ Test 4
Cardiology MCQ Online 4
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Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG Echocardiography Source Type: blogs
Cardiology MCQ Online 3
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You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. We strongly advise you t...
Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ Test 3
Cardiology MCQ Online 3
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Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ Test 2
Cardiology MCQ Online 2
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Source: Cardiophile MD - June 5, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ Source Type: blogs
