Coronary subclavian steal syndrome
Coronary subclavian steal syndrome is the diversion of blood from the coronary circulation to the exercising left upper limb after a coronary artery bypass graft (CABG) using left internal mammary artery [1]. This occurs when there is a high grade stenosis or occlusion of left subclavian artery proximal to the origin of the left internal mammary artery (LIMA). Though it is a rare phenomenon, it is a serious threat to the success of CABG. Cardiovascular manifestation of coronary subclavian steal syndrome could be angina, myocardial infarction, malignant arrhythmias or heart failure [1]. Cerebral symptoms can occur due to ...
Source: Cardiophile MD - April 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Acute aortic regurgitation
Clinical scenario of acute aortic regurgitation is quite different from familiar finding in chronic aortic regurgitation. Due to the atypical findings, it may be difficult to diagnose acute aortic regurgitation. All the same, it is not a stable condition like chronic aortic regurgitation. Acute regurgitation can rapidly progress to heart failure and early mortality if left untreated. Important causes of acute aortic regurgitation are infective endocarditis, aortic dissection, and rarely trauma [1]. Rare causes reported are necrotizing granulomatous inflammation of the aortic valve in rheumatoid arthritis [2] and avulsion...
Source: Cardiophile MD - April 13, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

GRIPHON Study on Selexipag
Selexipag is an orally active IP prostacyclin receptor agonist. It is structurally different from prostacyclin. GRIPHON was a phase 3 double blind randomized, placebo controlled trial which randomized 1156 patients with pulmonary arterial hypertension [1]. Patients included those who were not on treatment for pulmonary arterial hypertension and those on stable dose of endothelin receptor antagonist, phosphodiesterase 5 inhibitor or both. 181 centers from 39 countries participated in the GRIPHON study. Primary endpoint was a composite of death from any cause or complication related to pulmonary hypertension up to the end ...
Source: Cardiophile MD - April 13, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ISAR-REACT 5 Trial – Review
ISAR-REACT 5 Trial – Review ISAR-REACT 5 Trial [1] was a multicenter study with randomized patients who presented which acute coronary syndrome for whom an invasive strategy was planned, to either ticagrelor or prasugrel. It was an open label trial. Primary end point was a composite of death, myocardial infarction or stroke at one year. A major secondary safety endpoint was bleeding. This was an investigator-initiated trial funded by German Center for Cardiovascular Research and Deutsches Herzzentrum München (German Heart Center Munich). 4,018 patients were randomized in the study. Primary composite endpoint oc...
Source: Cardiophile MD - April 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

CULPRIT-SHOCK Clinical Trial – Review
CULPRIT-SHOCK Clinical Trial – Review Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial investigated two strategies for percutaneous coronary interventions (PCI) in acute myocardial infarction with cardiogenic shock [1]. It was a multicenter randomized trial involving 706 patients who were randomized to either immediate PCI of the culprit lesion only with option for staged PCI of non-culprit lesions or immediate multivessel PCI. Primary composite endpoint included death and severe renal failure leading to renal replacement therapy within 30 days after randomization. Primary co...
Source: Cardiophile MD - April 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs

Third heart sound in health and disease
Third heart sound (S3) occurs in early diastole due to rapid deceleration of transmitral blood flow as the ventricles fill [1]. It corresponds in timing to shortly after the peak of the early diastolic E wave of transmitral flow. S3 occurs just after the opening of the atrioventricular valve as blood filling the atria during ventricular systole flows quickly into the ventricles [2]. Third heart sound can occur under physiological conditions as well as in disease, though not heard in all individuals. A prospective study of 580 patients had isolated valvular mitral regurgitation in 299, aortic regurgitation in 121 and prim...
Source: Cardiophile MD - April 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Takayasu arteritis
Takayasu arteritis is an inflammatory disorder affecting aorta and its major branches. It is also known as aortoarteritis and pulseless disease [1]. Arteritis leads to thickening of vessel wall, fibrosis, stenosis and thrombus formation. Severe inflammation may weaken the arterial media and lead to aneurysm formation [2]. Takayasu was an ophthalmologist, who noted characteristic fundal arteriovenous anastomoses in a young female in 1905 and published it in Acta of the Opthalmic Society of Japan in 1908 (12:554–5). Onishi and Kagosha described similar cases associated with absent radial pulses in the same year [1].&...
Source: Cardiophile MD - April 7, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

CORAL study on renal artery stenting
In the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study, 947 patients who had atherosclerotic renal artery stenosis and either systolic hypertension while taking two or more antihypertensive medications or chronic kidney disease were evaluated. It was a multi-center, open-label, randomized, controlled trial. Patients were randomized to either medical therapy plus renal artery stenting or medical therapy alone [1]. Previous randomized trials on renal angioplasty had failed to show significant benefit in control of blood pressure [2,3]. Another two randomized trials checking the effect of renal artery...
Source: Cardiophile MD - April 7, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Innocent heart murmurs
Murmurs without any organic heart disease can be found in children. These have been called by various names like innocent murmur, physiological murmur, normal murmur and even functional murmur. But the term innocent murmur is preferred as it strongly conveys that nothing is abnormal [1]. Less than 1% of murmurs in children are due to congenital heart disease. Classical flow murmurs heard in children are Still’s murmur, pulmonary flow murmurs, systemic flow murmurs like supraclavicular systemic bruits and venous hum [1]. Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmu...
Source: Cardiophile MD - April 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Postural orthostatic tachycardia syndrome
Postural orthostatic tachycardia syndrome (POTS) is characterized by orthostatic tachycardia in the absence of orthostatic hypotension. Criteria for diagnosis of POTS are as follows: 1. Heart rate increase ≥30 beats per minute from supine to standing (5-30 min) 2. Symptoms get worse with standing and better on lying down 3. Symptoms lasting ≥6 months 4. Absence of other overt cause of orthostatic symptoms or tachycardia like active bleeding, acute dehydration and medications [1]. As children have higher orthostatic tachycardia, a cut off of ≥40 beats per minute within 5 minutes of head up tilt has been suggested...
Source: Cardiophile MD - April 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Importance of lead aVR
Lead aVR was often ignored as all the waves are inverted in aVR in contrast to other leads. Lead aVR is thought to point to the cavity of the heart. It has been called the neglected lead [1] and the forgotten lead [2]. Lead aVR came into limelight with the identification of the significance of ST elevation in the lead indicating left main coronary artery disease. Classical electrocardiographic pattern in left main coronary artery disease is ST segment elevation in aVR with extensive ST depression in other leads, most prominent in I, II and V4-V6 [3]. ST elevation in aVR can also occur in proximal left anterior descending...
Source: Cardiophile MD - April 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Role of Valsalva maneuver in cardiology
The initial description of Valsalva maneuver was published by Antonio Maria Valsalva in 1704. It was forced expiratory effort against the closed glottis, nose and mouth, lasting for a few seconds. The maneuver was employed with the aim of expelling foreign bodies or exudates from the middle ear [1]. Even today otolaryngologists use variations of the maneuver very often. Edward Weber in 1851 detailed the cardiovascular changes associated with maneuver, making it useful for diagnostic purpose. Hence some authors prefer to call it as Valsalva-Weber maneuver [2]. The classical four phases of Valsalva maneuver and its hemodyn...
Source: Cardiophile MD - April 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Echocardiographic assessment of patient-prosthesis mismatch
Patient-prosthesis mismatch is present when the effective prosthetic valve area is less than that of the normal human valve [1]. The reduction in valve area is usually mild to moderate and may not be off immediate clinical significance. Occasionally, it can be severe and patients may be hemodynamically and symptomatically worse after valve replacement. This typically occurs after aortic valve replacement for aortic stenosis as the aortic annulus is not dilated and permits insertion of only a smaller prosthetic valve compared to that in aortic regurgitation. Similar situation can be there after mitral valve replacement fo...
Source: Cardiophile MD - April 3, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs

Left ventricular remodeling
Left ventricular remodeling occurs in response to left ventricular stress and injury. It is progressive and occurs after large myocardial infarctions and dilated cardiomyopathy. Left ventricular volume increases and the normal elliptical shape becomes globular. Left ventricular remodeling is associated with changes at microscopic level which include myocyte hypertrophy, apoptosis and increased interstitial collagen deposition [1]. Left ventricular remodeling is a central pathophysiological mechanism in advancing heart failure. Reversal of remodeling with treatment is an important goal in the management of heart failure. ...
Source: Cardiophile MD - April 2, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Basic echocardiographic views
Echocardiography is now not restricted to the echocardiographic laboratory. It is used in the emergency department, at bedside, in the intensive care unit as well as in the operating room. Hence a basic knowledge is needed for all physicians and paramedics. Transthoracic echocardiography is often done from four echo windows. Echo windows are regions on the chest which permit imaging of the heart with least covering by the lungs. Echocardiographic windows The four common locations at which the echocardiographic transducer is placed for imaging are the parasternal, apical, subcostal, and suprasternal. Parasternal views are...
Source: Cardiophile MD - April 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography Source Type: blogs

Aquatic treadmill for exercise in the elderly
Aquatic or underwater treadmill exercise is gaining popularity as a means of exercise training in persons with osteoarthritis who cannot exercise on a land treadmill. Water jets opposite to the direction of walking can be used to achieve high ratings of perceived exertion in aquatic treadmill. Water currents in the direction of walking can also support higher speeds if needed, for a morale boost, in those with lower exercise capacity. The advantage of underwater treadmill is that there is no joint impact due to the body weight as occurs with land treadmill. Both motorised and non motorised versions of aquatic treadmills ...
Source: Cardiophile MD - March 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

H2FPEF score
H2FPEF score is a simple scoring system using clinical characteristics and echocardiography for differentiation of heart failure with preserved ejection fraction (HFpEF) from noncardiac causes of dyspnea [1]. H2FPEF score was developed by Reddy YNV et al using a derivation cohort of 414 consecutive patients comprising of 267 cases with HFpEF and 147 controls. The test cohort included 100 consecutive patients of which 61 had HFpEF. It was a retrospective study in consecutive patients with unexplained dyspnea referred for invasive hemodynamic exercise testing. The variables used and their weighted scores were as ...
Source: Cardiophile MD - March 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Phenogroups in heart failure with preserved ejection fraction
Clustering analysis of heart failure with preserved ejection fraction (HFpEF) has been used to define three distinct phenogroups by Shah SJ et al [1]. They used dense phenotypic data for “phenomapping”. They prospectively studied 397 HFpEF patients with clinical, laboratory and echocardiographic data. Several statistical algorithms were used to define and characterize mutually exclusive phenogroups of HFpEF. By phenomapping analysis they arrived at 3 distinct phenogroups with markedly different clinical characteristics, cardiac function, invasive hemodynamic patterns and outcome. There were different characte...
Source: Cardiophile MD - March 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Obesity and Low BNP
B type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) are often estimated in patients presenting with breathlessness to look for evidence of heart failure. In obese patients, clinical findings, chest X-ray and even bedside echocardiography has limitations in the diagnosis of heart failure. Abdominal obesity can even cause orthopnea like presentation due to elevated levels of diaphragm. Hence we are more likely to look at BNP/NT-proBNP to establish heart failure in the emergency room. But there is a great limitation for these estimations as BNP levels may be low due to obesity. An inverse relationship between ...
Source: Cardiophile MD - March 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Transpulmonary gradient and diastolic pressure gradient
Transpulmonary gradient (TPG) is defined as the difference between the mean pulmonary arterial pressure and the left atrial pressure, which is usually equal to pulmonary capillary wedge pressure (PCWP) [1]. When transpulmonary gradient is>12 mm Hg in left heart disease, it is considered as out of proportion pulmonary hypertension indicating pulmonary vascular disease. Diastolic pulmonary gradient (DPG) is the difference between the pulmonary artery diastolic pressure and pulmonary capillary wedge pressure. Diastolic pulmonary gradient is important in patients with out of proportion pulmonary hypertension in left heart...
Source: Cardiophile MD - March 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Annulus paradoxus and annulus reversus on tissue Doppler in constrictive pericarditis
Annulus paradoxus The term “annulus paradoxus” was proposed by Ha JW et al to indicate the inverse correlation of E/E’ to pulmonary capillary wedge pressure (PCWP) on tissue Doppler evaluation in constrictive pericarditis. Usually a positive correlation is found in patients with primary myocardial disease between E/E’ and PCWP [1]. In their study of 10 patients, E’ was not elevated despite high left ventricular filling pressures. Hence E/E’ was low, with a mean 9 and it was
Source: Cardiophile MD - March 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs

Estimation of PCWP from E/E ’ on Tissue Doppler Imaging
Estimation of PCWP from E/E’ on Tissue Doppler Imaging Conventionally, pulmonary capillary wedge pressure (PCWP) is measured using a catheter in the pulmonary artery. Pulmonary artery diastolic pressure measured by a Swan Ganz balloon floatation catheter at bedside is often taken as the surrogate of PCWP. Ideal method of bedside measurement is balloon occlusion of a pulmonary artery branch to get the distal pressure. But it cannot be done on a continuous basis as it will compromise flow to the territory and vascular complications can ensue. True PCWP, as the name implies, is obtained after wedging an end hole cathet...
Source: Cardiophile MD - February 27, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Estimation of PCWP from E/E' Nagueh formula Source Type: blogs

Elevated prosthetic valve gradients
Elevated gradients across prosthetic valves can occur due to various reasons. But before declaring that prosthetic valve gradients are elevated, the usual gradient across the given type of prosthetic valve should be known. Different types of normally functioning prosthetic heart valves have different gradients. Normal gradient is different between the various valve positions. Transmitral prosthetic valve gradient is lower than transaortic prosthetic valve gradient. If the gradient during post operative review is available, it can be used as a benchmark for comparison. Some of the important causes for elevated prosthetic ...
Source: Cardiophile MD - February 27, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Echocardiography Source Type: blogs

Low gradient severe mitral stenosis
Low gradient severe mitral stenosis has been defined as mean transmitral gradient
Source: Cardiophile MD - February 26, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs

Valvuloarterial impedance (Zva): Global left ventricular afterload in aortic stenosis
Valvuloarterial impedance (Zva) is an echocardiographic measure of global left ventricular afterload in aortic stenosis [1]. It accounts for the effect of both aortic stenosis and systemic arterial compliance. Zva (mmHg/ml/m2) = (systolic blood pressure + mean transvalvular pressure gradient)/stroke volume index Here the systemic arterial pressure and mean transvalvar gradient are taken beyond the region of pressure recovery in aortic stenosis. This mean transvalvar gradient has been called the net mean gradient. In a study of 208 patients with at least moderate aortic stenosis, Briand M and c...
Source: Cardiophile MD - February 26, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Aortic stenosis aortic stenosis with hypertension Global left ventricular afterload Global left ventricular afterload in aortic stenosis mean transvalvar gradient net mean gradient pressure recovery in aortic stenosis Valv Source Type: blogs

Discordant grading of severity of aortic stenosis
Discordance between various measures of severity of aortic stenosis (AS) is considered as discordant grading of severity of aortic stenosis or simply discordant AS. Severe aortic stenosis has aortic Vmax ≥4.0 m/s, mean gradient ≥40 mm Hg and effective orifice area (EOA) ≤1.0 sq. cm. Peak aortic velocity and mean gradient are flow dependent measurements, while effective orifice area and Doppler velocity index are relatively flow independent. About 20-30% of patients may have discordant measures of severity of aortic stenosis on echocardiography [1]. Discordance is mostly between effective orifice area and Vmax/Do...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography discordant aortic stenosis discordant AS hybrid imaging hybrid imaging to assess LVOT measurement pseudo severe aortic stenosis pseudo severe AS Source Type: blogs

Phenocopies of hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is characterized by hypertrophy of the left ventricle, not related to load. It is a genetically transmitted condition. There are several mimickers of hypertrophic cardiomyopathy which can be called phenocopies of hypertrophic cardiomyopathy. Conventional form of HCM has been called sarcomeric HCM as it is due to mutations in genes encoding sarcomeric proteins [1]. Here is a small list of phenocopies of hypertrophic cardiomyopathy which is not truly exhaustive: Fabry disease Danon disease PRKAG2 Cardiomyopathy Pompe disease Cardiac amyloidosis Athlete’s heart Hypertensive heart dise...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Mimickers of HCM Mimickers of hypertrophic cardiomyopathy Mimics of HCM Mimics of hypertrophic cardiomyopathy Source Type: blogs

ePLAR: Echocardiographic Pulmonary to Left Atrial Ratio
ePLAR is a simple echocardiographic estimation useful in differentiating pre-capillary from post capillary pulmonary hypertension [1]. ePLAR = TR Vmax/(Mitral E/e’) ePLAR: Echocardiographic pulmonary to left atrial ratio TR Vmax: Maximum velocity of tricuspid regurgitation jet by Doppler echocardiography in m/s E: E wave in the mitral flow Doppler e’: Septal mitral annular tissue Doppler velocity ePLAR values are lower in post-capillary pulmonary hypertension. E/e’ reflects left ventricular filling pressure which is left atrial pressure. TR Vmax reflects the pulmonary artery systolic pressure. That is h...
Source: Cardiophile MD - February 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs

Intermittent LBBB and P Mitrale or Tricuspidale?
Intermittent LBBB and P Mitrale or Tricuspidale Intermittent left bundle branch block pattern is seen as wide notched QRS complexes with cycle length of 570 ms. Narrower QRS complexes at cycle length of 600 ms are seen towards the end of the tracing. This can be considered as phasic aberrancy which is rate dependent. Classically rate dependent left bundle branch block is deceleration dependent rather than acceleration dependent. Acceleration dependent block is usually right bundle branch block. P waves are wide and notched, suggesting left atrial overload. But close scrutiny shows that the initial peak is taller than the...
Source: Cardiophile MD - February 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Chest X-ray after mitral annuloplasty
Chest X-ray after mitral annuloplasty Chest X-ray after mitral annuloplasty shows sternal wires, left atrial enlargement and prominent left atrial appendage (Third mogul sign). Annotated picture is given below: Post mitral annuloplasty CXR Prominent upper lobe vessels indicate pulmonary venous hypertension. Double atrial contour is the left atrial contour seen within the right atrial contour. Right atrium is also enlarged as indicated by the increased distance of the right atrial border from the midline. These findings might have been there prior to annuloplasty and not regressed well after the procedure. The post Chest X...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology X-ray left atrial enlargement third mogul sign Source Type: blogs

Bicuspid aortic valve and eccentricity index
Bicuspid aortic valve and eccentricity index The M-mode echocardiogram shows eccentric valve closure in diastole. Systolic opening of the valve is good. Eccentricity index for a bicuspid aortic valve is calculated as follows [1]: 1/2 of aortic lumen diameter divided by minimum distance of diastolic cusp echo from nearest aortic margin The measurement is illustrated in the image below: Eccentricity index in bicuspid aortic valve The diastolic diameter of the aorta is represented by A. Half of it is taken for the calculation of eccentricity index. B represents the minimum distance of diastolic cusp echo from nearest aortic...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography Source Type: blogs

Giant T inversion and NSVT
Giant T inversion with NSVT Holter tracing showing giant T wave inversion and non sustained ventricular tachycardia, both at the beginning of the tracing and at the end. Ventricular ectopic beats are also seen in between. Variation in QRS amplitude of the NSVT beats are evident. It is likely that this will soon progress to torsades des pointes in the setting of gross QT interval prolongation. QT interval is seen as 640 ms in a cycle with cycle length of 600 ms. So, the QTc will be 640 ms. The first ventricular ectopic is followed by a good compensatory pause while the second one is almost an interpolated ventricular ecto...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Septal bounce and septal shudder in constrictive pericarditis
Septal bounce Septal bounce is also called respirophasic ventricular septal shift [1, 2]. It is an early diastolic posterior motion of the interventricular septum.  Septal bounce is a sign of ventricular interdependence noted in constrictive pericarditis. The sign may be seen on echocardiography, cardiac magnetic resonance imaging and cardiac computed tomography. Mechanism has been studied by simultaneous cardiac catheterization and echocardiography [2]. Septal bounce was the most consistent sign among 39 cases of constrictive pericarditis evaluated by two independent observers in a study [3]. Septal ‘bounce&r...
Source: Cardiophile MD - January 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Magnetic Resonance imaging Echocardiography respirophasic ventricular septal shift septal bounce septal bounce in constrictive pericarditis septal shudder septal shudder in constrictive pericarditis ventricular interdependence Source Type: blogs

Percutaneous debulking of large vegetations
Percutaneous debulking of large vegetations in infective endocarditis is being followed, especially in cardiac implantable device related infections. It is useful in reducing the risk of massive embolism during lead extraction [1]. In a report of six cases done along with lead extraction, there were no operative deaths or clinically significant embolic events [1]. But non fatal complications were higher in those who had vacuum assisted debulking of vegetations along with lead extraction, compared to those who underwent only lead extraction. AngioVac system (Angio-Dynamics, Latham, NY, USA) was used in this study. A syste...
Source: Cardiophile MD - January 11, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions ECG / Electrophysiology Source Type: blogs

ECMO – Extracorporeal membrane oxygenation
ECMO – extracorporeal membrane oxygenation ECMO – Extracorporeal membrane oxygenation – has been in use for the past four decades to support persons who are unlikely to survive with mechanical ventilation. ECMO is used in both adult and pediatric practice, though in the initial years, use of ECMO was restricted to pediatric intensive care. The enthusiasm for use of ECMO in adults have been triggered by the beneficial effect noted during the last H1N1 influenza pandemic [1]. In contrast from cardiopulmonary bypass which is used for a short period during cardiac surgery, ECMO is used to support for a ...
Source: Cardiophile MD - December 26, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs

Modified Blalock – Taussig shunt
Modified Blalock – Taussig shunt The original Blalock – Taussig (BT) shunt was designed by Helen B Taussig (physician) and Alfred Blalock (surgeon) at the John Hopkins Hospital. This was based on the observation by Helen B Taussig that infants with severe pulmonary stenosis or pulmonary atresia had worsening of cyanosis after spontaneous closure of ductus arteriosus. The BT shunt was an anastomosis between subclavian artery and pulmonary artery, to enhance pulmonary blood flow those infants with severe cyanotic congenital heart disease with low pulmonary blood flow. Different techniques have been used to modify...
Source: Cardiophile MD - December 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Blalock – Taussig shunt BT shunt classic Blalock – Taussig shunt Modified Blalock – Taussig shunt modified BT shunt Source Type: blogs

Mogul signs on chest X-ray
This article has been cited in Chest [2]. A mogul can form due to left ventricular pseudoaneurysm after mitral valve replacement [3]. Early recognition of this is important as pseudoaneurysms are prone for rupture with catastrophic results. Mogul signs on chest X-ray In addition to the mogul signs, the chest X-ray shows prominent upper lobe vessels (antler sign) and double atrial shadow or shadow within shadow of left atrial enlargement. The left atrial shadow is seen as a double density within the right atrial shadow as part of the enlarged left atrium extends posterior to the right atrium. All these features are suggesti...
Source: Cardiophile MD - December 20, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology X-ray Source Type: blogs

FFR with CT angiography
Fractional flow reserve (FFR) is usually estimated invasively using a Doppler flow wire introduced into the coronary artery and measuring the pressure drop across the coronary stenosis during maximal hyperemia induced by adenosine. FFR has been shown to be of great significance while assessing the severity of borderline coronary stenosis in deciding the need for coronary angioplasty. Fractional flow reserve estimated by computed tomographic angiography (FFRCT) is a novel technique of getting similar information non invasively. FFR with CT angiography has been shown to be superior to conventional CT coronary angiography a...
Source: Cardiophile MD - December 18, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac CT scan FFR FFRCT Noninvasive Fractional Flow Reserve Source Type: blogs

Electrical storm – Management
Electrical storm – Management Electrical storm: Recurrent unstable ventricular tachycardia (VT)/ventricular fibrillation (VF) requiring more than three direct current (DC) shocks per day. Beta blocker is the single most effective therapy for recurrent VT unless the person is in shock. A combination of intravenous amiodarone with oral propranolol has been found to be superior to intravenous amiodarone with oral metoprolol [1]. Stellate ganglion block / ablation is being increasingly used as a modality for treatment of drug refractory ventricular tachycardia. Temporary blockage of stellate ganglion can be obtained by...
Source: Cardiophile MD - December 18, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Ablation of stellate ganglion Stellate ganglion block Temporary blockage of stellate ganglion Source Type: blogs

Dangerous Signs on Holter Monitoring
Holter monitoring is ambulatory monitoring using a digital recorder attached to a belt. Two or three channels are usually recorded with an appropriate number of patch electrodes attached to the chest. Twelve channel Holter monitoring can also be done using standard lead placement [1]. Holter monitoring is usually done when an arrhythmia is suspected, though ischemic ST segment deviation can also be picked up by Holter. Dangerous signs to look for on a Holter tracing are life threatening bradyarrhythmias and tachyarrhythmias. Dangerous bradyarrhythmias are long pauses or episodes of complete heart block with low ventricul...
Source: Cardiophile MD - December 17, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Wrong statement about Mahaim fiber tachycardia – Cardiology MCQ – Answer
Wrong statement about Mahaim fiber tachycardia – Cardiology MCQ – Answer Correct answer: 3. Mahaim fiber tachycardia is always orthodromic Mahaim fibers do not conduct retrogradely. So Mahaim fiber tachycardia is always with wide QRS complexes, antidromic with LBBB pattern. It may be noted that in WPW syndrome both narrow QRS (orthodromic) and wide QRS (antidromic) tachycardia are possible as the pathway can conduct both anterogradely and retrogradely. Kent bundle responsible for WPW syndrome does not have decremental conduction, which is a usual property of the atrioventricular (AV) node. Read more on Mahaim f...
Source: Cardiophile MD - December 13, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Wrong statement about Mahaim fiber tachycardia – Cardiology MCQ
Wrong statement about Mahaim fiber tachycardia – Cardiology MCQ Decremental conduction No delta wave Mahaim fiber tachycardia is always orthodromic Mahaim fibers do not conduct retrogradely Post your answer as a comment below. Correct answer will be posted after 2 days. The post Wrong statement about Mahaim fiber tachycardia – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - December 11, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Rautaharju and Dmitrienko formulae for QT interval correction
Various logarithmic and linear formulae for correction of QT interval has been discussed before. These include Bazett’s formula, Fridericia’s formula and Baseline correction for logarithmic correction and Framingham formula and Hodges formula for linear correction. Of these, Bazett’s and Fridericia’s were introduced in 1920 (exactly one century back!). Rautaharju’s formula and Dmitrienko’s formula are two relatively recent formulae for correction of QT interval. The older formulae have problems during calculation of QTc during exercise. QTc using Bazett’s formula increased with ex...
Source: Cardiophile MD - November 26, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Dmitrienko QTc formula Karjalainen QTc nomogram QT correction nomogram Rautaharju QTc formula Source Type: blogs

Rheumatic heart disease
This lecture will discuss about rheumatic fever, latest diagnostic criteria (Revised by American Heart Association in 2015), and an overview of rheumatic heart disease. Echocardiogram pictures and brief discussion of catheter based, and surgical management are added. The post Rheumatic heart disease appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - November 24, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Aortic regurgitation Aortic stenosis Austin Flint murmur Graham Steell murmur mitral regurgitation mitral stenosis Pulmonary regurgitation Tricuspid regurgitation Tricuspid stenosis Source Type: blogs

Coronary artery disease
This lecture will give an overview of coronary artery disease including the universal definition of myocardial infarction. The new term chronic coronary syndrome will be introduced. Coronary artery disease or CAD is known by various names like ischemic heart disease, atherosclerotic coronary heart disease and coronary heart disease. The post Coronary artery disease appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - November 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Acute coronary syndrome Chronic coronary syndrome myocardial infarction Perioperative myocardial infarction periprocedural myocardial infarction troponin elevation Universal definition of myocardial infarction unstable angina unstabl Source Type: blogs

RWMA – Echo
RWMA – Echo The term regional wall motion abnormality or RWMA can be used in any imaging which shows movements of the myocardial segments like echocardiography, cine cardiac magnetic resonance imaging, cine computed tomography and nuclear cardiology imaging. The left ventricular myocardium has been divided into 17 segments by the American Society of Echocardiography [1]. The true apex is a separate segment in this 17-segment nomenclature. In the previous 16 segment nomenclature, there is no separate true apical segment. True apical segment is beyond the left ventricular cavity towards the apex. More details at: Desc...
Source: Cardiophile MD - November 20, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography 17 myocardial segments echocardiographic myocardial segments Regional wall motion abnormality RWMA Source Type: blogs

Atrial septal defect
This video covers certain features of atrial septal defect including X-ray chest, ECG, echocardiogram and finally device closure of ASD. Both secundum and primum ASDs are demonstrated. Transesophageal echo images of ASD are also shown. Fluoroscopic view of ASD device with delivery cable and venous sheath is seen at the end. Another video without narration, showing TEE in dual ASD is shown below: (Source: Cardiophile MD)
Source: Cardiophile MD - November 20, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography ASD ASD device closure dual ASD ostium primum ASD ostium secundum ASD TEE in ASD Source Type: blogs

Cardiology X-ray chest PA view
In this lecture, we will have an overview of Cardiology X-ray Chest PA view. This will cover pulmonary veins, pulmonary arteries, various cardiac chamber enlargements, prosthetic heart valves, cardiac implantable electronic devices like pacemakers, cardiac resynchronization therapy and implantable cardioverter defibrillator appearances on chest X-ray. (Source: Cardiophile MD)
Source: Cardiophile MD - November 12, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology cardiac chamber enlargementg cardiac implantable electronic devices like pacemakers implantable cardioverter defibrillator prosthetic heart valves pulmonary arteries pulmonary artery Source Type: blogs

Clinical Examination of Cardiovascular System
This lecture gives a comprehensive coverage of clinical examination of the cardiovascular system including inspection, palpation, percussion and auscultation. A previous lecture on important symptoms of heart disease is a companion to this lecture: https://www.youtube.com/watch?v=3eO-yOQsx4U (Source: Cardiophile MD)
Source: Cardiophile MD - November 12, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology auscultation cardiac murmurs Cardiovascular system examination Clinical examination clubbing of digits differential clubbing differential cyanosis Erb’s area facial dysmorphism general examination Gibson’s area Gibso Source Type: blogs

ECG basics
Electrocardiogram is the recording of the electrical signals of the heart. Electrocardiogram (ECG) recorded from the body surface is known as surface ECG while that recorded with intracardiac electrodes are called electrograms. Standard surface ECG uses four electrodes on the limbs of which one is an indifferent electrode and 6 electrodes on the chest. Various combinations of limb electrodes record 6 ECG leads while chest electrodes record 6 chest leads to make a total of 12 leads in the standard 12 lead ECG. The leads can be recorded in sequence, groups of 3 each or simultaneous 12 leads. Multiple simultaneous leads are...
Source: Cardiophile MD - November 11, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG standardization left ventricular hypertrophy left ventricular volume overload P congenitale P mitrale P pulmonale P tricuspidale Pardee's sign Pardee's sign on ECG right ventricular volume overload Source Type: blogs