Echo drop out in interatrial septum
An echo drop out in the interatrial septum is often noted in the apical four chamber view. This need not mean that there is an atrial septal defect. This is because the thin atrial septum in the region of the foramen ovale is often not imaged well in the apical four chamber view as the ultrasound beam is parallel to the inter atrial septum. For a good ultrasound image, the structure being imaged should be perpendicular to the ultrasound beam. In case of Doppler the beam should be parallel to the flow being imaged. LV: left ventricle; RV: right ventricle; LA: left atrium; RA: right atrium; PV: pulmonary vein; IAS: inter atr...
Source: Cardiophile MD - December 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Atrial septal defect (ASD) with bidirectional shunt
Subcostal four chamber view shows a large defect in the interatrial septum (ASD). Right atrium (RA) and right ventricle (RV) are dilated, while left atrium (LA) and left ventricle (LV) are not. Blue color on colour flow mapping indicates right to left shunt across the atrial septal defect (R>L Shunt) in the subcostal view as the flow is away from the transducer.
This view shows red coloured flow across the ASD indicating a left to right shunt (L>R shunt). In addition there is a mosaic (multicoloured) jet spreading from the closed tricuspid valve into the right atrium, due to tricuspid regurgitation (TR jet).
Bidirec...
Source: Cardiophile MD - November 29, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Subcostal four chamber view – Echocardiography
Subcostal four chamber view is excellent for visualization of interatrial septum (IAS). If an atrial septal drop out is seen in the apical four chamber (4C) view, it need not be an atrial septal defect as the IAS is parallel to the ultrasound beam in the apical 4 C view. Structures are imaged well only if they are perpendicular to the ultrasound beam. In case of Doppler, the signals are better when it is parallel to the beam. If the beam is perpendicular to the flow, there is hardly any Doppler signal picked up. Subcostal four chamber view shows right atrium (RA), left atrium (LA), right ventricle (RV) and the left ventric...
Source: Cardiophile MD - November 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Device closure of atrial septal defect (ASD)
Device closure of ASD
Device closure of ASD is suitable for secundum ASD with a good rim all around for holding the two discs together. Trans esophageal echo (TEE) is done to assess the superior, aortic and mitral rims as well as the total septal length. It is ideal to have TEE guidance during the procedure as well. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the ASD. The tip of the wire is placed in the pulmonary vein and a long venous sheath is introduced. Once the sheath is in position, the device attached to the delivery cable is introduce...
Source: Cardiophile MD - September 17, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 5
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Source: Cardiophile MD - August 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 1
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Source: Cardiophile MD - June 28, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 26
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Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Echo Quiz – Cardiology MCQ
Type of ASD seen in this echo:
a) Sinus venosus
b) Secundum
c) Primum
d) None of these
Correct answer: b) Secundum
There is good rim of septal tissue between the atrial septal defect and the atrioventricular valves, suggesting secundum ASD. In sinus venosus ASD, the superior rim will not be there. (Source: Cardiophile MD)
Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology X-ray DM / DNB Cardiology Entrance Echocardiography Source Type: blogs
Cardiology X-ray Quiz – Cardiology MCQ
This chest X-ray is suggestive of:
a) Primary pulmonary hypertension
b) Atrial septal defect with pulmonary hypertension
c) Ventricular septal defect with pulmonary hypertension
d) Idiopathic dilatation of pulmonary artery
Correct answer: b) Atrial septal defect with pulmonary hypertension
End on view of dilated pulmonary artery branches suggest increased pulmonary blood flow as the cause of pulmonary hypertension. Right atrial enlargement is not seen in ventricular septal defect with pulmonary hypertension. Read more on multi-modality imaging in atrial septal defect… (Source: Cardiophile MD)
Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Cardiology X-ray DM / DNB Cardiology Entrance Source Type: blogs
Deficiency of aortic rim an important risk factor for cardiac erosion with ASD device
Cardiac erosion is a potential nightmare of device closure of atrial septal defect (ASD) device closure, though exceedingly rare. Recent study published in Circulation [1] documented 125 erosions over a period of 12 years from a database. Erosions were diagnosed over a median of 14 days after the device closure. Deficiency of aortic rim was found to be almost universal while deficiency of any of the aortic, superior vena caval or inferior vena caval rims were the most important risk factor for cardiac erosion. The study was a case control study with age and sex matched controls. Device oversizing also contributed to the c...
Source: Cardiophile MD - May 4, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 23
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Source: Cardiophile MD - March 25, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 21
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Source: Cardiophile MD - March 8, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 17
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Source: Cardiophile MD - February 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 11
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Source: Cardiophile MD - February 3, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Narrative Matters: On Our Reading List
Editor’s note: “Narrative Matters: On Our Reading List” is a monthly roundup where we share some of the most compelling health care narratives driving the news and conversation in recent weeks.
Disability In STEM
Jesse Shanahan, a master’s student in astronomy at Wesleyan University, has a physical disability. That makes her rare among students in the STEM (Science, Technology, Engineering, and Math) fields, where only 9 percent to 10 percent of undergraduates, and only 1 percent of Ph.D. recipients, in the United States have disabilities.
Beyond the physical barriers she faces—like inaccessible buildings...
Source: Health Affairs Blog - January 28, 2016 Category: Health Management Authors: Jessica Bylander Tags: Elsewhere@ Health Affairs Featured Narrative Matters clinical trials Disabilities On Our Reading List Source Type: blogs
