How to check for pulsus paradoxus?
Pulsus paradoxus is an exaggeration of the normal inspiratory fall in blood pressure. The paradox in pulsus paradoxus is that the pulse is not well felt when the heart sounds are still audible. The extent of fall in inspiratory pressure can be documented using a sphygmomanometer. Pulsus paradoxus Pulsus paradoxus is the typical finding in cardiac tamponade, though it can occur more commonly in obstructive airways disease. In obstructive airways disease, it is due to the wide swing in intrathoracic pressure. Other less likely causes are constrictive pericarditis and restrictive cardiomyopathy. It has also been reported in ...
Source: Cardiophile MD - December 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Basics of hemodynamic evaluation – 3
Basics of hemodynamic evaluation – 3 While evaluating intracardiac shunt lesions by cardiac catheterization, an easy way is to look at the step up or step down in the oxygen saturation between two chambers. For example, in case of left to right shunts, step up is noted between superior vena cava (SVC) and right atrium in case of atrial septal defect (ASD). Among the atrial septal defects, step up is noted in high right atrium for sinus venosus ASD, mid right atrium for secundum ASD and low right atrium for primum ASD. Step up from right atrium to right ventricle is noted in ventricular septal defect. In case of paten...
Source: Cardiophile MD - December 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Basics of hemodynamic evaluation – 2
Basics of hemodynamic evaluation – 2 Click here to see Part 1 This is the article in the series on basics of hemodynamic evaluation. As mentioned earlier, pressure measurement in each chamber is an important aspect of hemodynamic evaluation. Two types of catheter based pressure measurements are possible. One is using a catheter tipped manometer, which is more ideal, but expensive. Second, more commonly used method is using fluid filled systems with an external transducer. While using fluid filled systems, care has to be taken to avoid air bubbles in the connecting tubings to avoid damping of pressure wave transmissio...
Source: Cardiophile MD - December 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

What is the scientific basis of 10,000 steps a day?
It is often suggested that you should take 10,000 steps a day, seven days a week as part of your fitness program. Actually the number of steps need not assess the amount of walking you do. The distance walked will depend on your stride length. Anyway the concept of 10,000 steps a day is quite popular and many use pedometers to track the daily step count and often post it on social media to encourage others. Thought of just looking at PubMed on the scientific data on the utility of 10,000 steps a day. Ohta T and colleagues checked the effect on coronary risk factors in obese middle aged subjects and the data was published ...
Source: Cardiophile MD - December 7, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Basics of hemodynamic evaluation
Though invasive hemodynamic evaluation was pushed to the backstage with the development of Doppler echocardiography, it is again coming to centre stage with newer therapeutic options being available in pulmonary hypertension and heart failure. A basic knowledge of the principles of hemodynamic evaluation is essential to understand cardiac physiology. Hemodynamic evaluation usually includes both right and left heart catheterization, though in some cases only one may be done. While writing a report of hemodynamic evaluation, it is customary to note the catheter course as it gives valuable complementary information. Catheter...
Source: Cardiophile MD - December 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

EINSTEIN-Jr clinical trials of Rivaroxaban in children
Rivaroxaban is useful for treatment of venous thromboembolism in adults and is associated with lower risk of bleeding compared to standard anticoagulants. EINSTEIN-Jr phase 2 used bodyweight adjusted rivaroxaban for children with venous thromboembolism [1]. It was a single arm multicenter study three age groups – children younger than 6 months, those in age group 6 months to 5 years and in children and adolescents between 6-17 years. Studies were done at 54 sites across Australia, Europe, Israel, Japan and North America. The study was in children with confirmed venous thromboembolism who have been treated for at lea...
Source: Cardiophile MD - November 25, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

INTERMACS classification for advanced heart failure
INTERMACS classification for advanced heart failure was developed as a sub classification for advanced heart failure, typically for those in advanced NYHA (New York Heart Association) Functional Class III and IV. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) developed this classification with seven clinical profiles and an arrhythmia modifier [1].  This was to allow optimal selection of patients for medical and pacing therapies, cardiac transplantation and mechanical circulatory support. They found that 80% of current devices are being used in 2 profiles with the highest level of clinical...
Source: Cardiophile MD - November 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Important aspects in the management of neurocardiogenic syncope
Neurocardiogenic syncope is the most common cause of syncope. Initial measures in management include lifestyle modifications, increasing the fluid and salt intake and education about physical counterpressure methods. Pharmacological measures may be tried next. Pacemaker implantation has been tried in those with predominantly cardioinhibitory syncope [1]. Physical counterpressure measures are movements like leg crossing and hand gripping which may prevent loss of consciousness in those who feel the presyncopal symptoms. These measures increase the systemic vascular resistance and blood pressure to counter the vasodepressiv...
Source: Cardiophile MD - November 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Drug coated balloons in coronary artery disease
Drug coated balloons are a novel therapeutic option in certain situations of coronary artery disease. An established use of drug coated balloon is for in-stent restenosis of both bare metal and drug eluting stents [1]. Drug coated balloon transfers antiproliferative drugs into the vessel wall during single balloon inflation. This is done by means of a lipophilic matrix. The advantage over drug eluting stent is that there is no permanent implant. Drug eluting stents have the disadvantages of neo-atherosclerosis and stent thrombosis. Even temporary implants like bioresorbable scaffolds have elevated thrombotic risk. Drug co...
Source: Cardiophile MD - November 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs

Is too much of exercise bad for you?
It is well known that regular exercise is good for the heart. Almost all guidelines recommend 150 minutes a week of moderate intensity physical activity. But like the old saying that too much of good things can be harmful, is too much exercise bad for you? The Copenhagen City Heart Study assessed the dose of jogging and long term mortality [1]. In the introduction of their article, they mentioned the historical anecdote of sudden death of Pheidippides, a professional running courier in 490 BC. It is believed that he ran from Marathon to Athens, Greece, approximately 25 miles to give the news of victory of Athens overs Per...
Source: Cardiophile MD - November 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Mitral valve area by pressure half time
Measurement of mitral valve area by pressure half time is an often applied method using Doppler echocardiography. Mitral valve area by pressure half time Mitral valve area can be calculated from the pressure half time (PHT) of the initial downward slope of the mitral A wave, which fuses with the E wave in mitral stenosis. Lower the slope, lower the mitral valve area and higher the severity of mitral stenosis. Pressure half time is the time taken for the gradient to reduce to half of its peak value. PHT 220 ms corresponds to a mitral valve area of 1 square centimeter. Here the PHT is 163 ms, hence mitral valve area will be...
Source: Cardiophile MD - November 13, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs

Alcohol Ablation of Vein of Marshall for Persistent Atrial Fibrillation
Highly diagrammatic representation of coronary veins Vein of Marshall (VOM) is a tributary of the coronary sinus with abundant sympathetic and parasympathetic innervation. It has been implicated in the genesis and maintenance of atrial fibrillation (AF).  Three reasons described are the myocardial extensions into the structure, node like remnants within the vein and the rich autonomic innervation surrounding it [1] It is anatomically related to the mitral isthmus. Mitral isthmus is the region between the left inferior pulmonary vein ostium and the mitral annulus. Oblique vein of Marshall is the residua of the embryonic l...
Source: Cardiophile MD - November 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Mural endocarditis
Vegetations in infective endocarditis are usually situated on the valves. If they are located on the walls of the cardiac chambers, it is known as mural endocarditis [1]. When mural endocarditis occurs without any cardiac structural abnormalities like ventricular septal defects, it is called primary mural endocarditis [2]. Primary mural endocarditis is extremely rare. Left atrial mural endocarditis usually occurs due to the jet lesion of mitral regurgitation [1,3]. Left atrial mural endocarditis is usually picked up by trans esophageal echocardiography. Vegetations are mostly located just distal to the mitral orifice betw...
Source: Cardiophile MD - October 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Extremely high HDL – beneficial or harmful?
This study showed extremely high HDL was associated with lower risks for all-cause mortality and cardiovascular events compared to low HDL. But they had higher risks compared to very high HDL. Paradoxically high all-cause mortality in those with extremely high HDL has also been reported in another study of 52 268 men and 64 240 women [5]. Though most of these studies showed a negative role for extremely high HDL, there is recent study from Korea which showed that extremely high HDL was not associated with increased risk of mortality, myocardial infarction and stroke [6]. That study with 343,687 subjects also defined extrem...
Source: Cardiophile MD - October 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Systemic right ventricle – Cardiology MCQ – Answer
Systemic right ventricle – Cardiology MCQ – Answer Systemic right ventricle can be seen in all of the following except: Correct answer: 2. Following arterial switch operation for complete transposition of great arteries In arterial switch operation (Jatene procedure), normal anatomical relationship is restored by switching the aorta and pulmonary artery so that aorta arises from the left ventricle and pulmonary artery arises from the right ventricle. Hence it is a systemic left ventricle and pulmonary right ventricle. Systemic right ventricle is seen after atrial switch repair for complete transposition of gre...
Source: Cardiophile MD - October 11, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs