Triboelectric pacemaker powered by cardiac contractions
Usually modern pacemakers are powered by built-in batteries and you need to replace the pulse generator when the battery reaches end of life. What if the device gets charged itself using energy of cardiac contractions? That is exactly what a triboelectric pacemaker powered by cardiac contractions aims to achieve. Triboelectric effect is typically the static electricity which is generated when a plastic comb is used on dry hair. Researchers have tested a symbiotic cardiac pacemaker which uses an implantable triboelectric nanogenerator (iTENG) which harvests energy from cardiac contractions and stores in a capacitor [...
Source: Cardiophile MD - April 24, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Opposing views on Breakfast
This study by Rong S et al in The Journal of American College of Cardiology says that if you skip breakfast, you have a significantly increases risk of mortality from cardiovascular disease. Authors concluded that eating breakfast promotes cardiovascular health. Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials [2] This study by Sievert K and colleagues published in the British Medical Journal concluded that the addition of breakfast might not be a good strategy for weight loss, regardless of the regular breakfast habit. They cautioned t...
Source: Cardiophile MD - April 23, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Optical frequency domain imaging (OFDI)
Optical frequency domain imaging (OFDI) is a novel second generation optical coherence tomography (OCT) derived imaging method [1]. It has substantially higher speed of image acquisition compared to first generation time domain OCT. OFDI can allow rapid imaging for detection of coronary strut coverage with a much higher precision compared to intravascular ultrasound. Axial resolution of OFDI is in the range of 10-20 microns. OPINION trial compared optical frequency domain imaging vs. intravascular ultrasound (IVUS) in percutaneous coronary intervention [2]. It was a prospective, multicentre, randomised, active-controlled...
Source: Cardiophile MD - April 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Source Type: blogs

Implantable STEMI monitor
AngelMed Guardian system (Angel Medical Systems, Eatontown, New Jersey) is an implantable device which detects ischemic events using a pacemaker lead positioned at right ventricular apex [1]. The device detects ischemic events by analyzing shifts in ST segment. It compares ST deviation of a 10 second electrogram with baseline data. If the shift in ST segment is greater than the heart rate dependent programmable threshold, an emergency alert signal is generated. The implantable device gives a vibratory alert and an external associated device gives auditory and visual alert. ALERTS (AngelMed for Early Recognition and Treat...
Source: Cardiophile MD - April 19, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ECG Quiz 57 – Discussion – Incognito Paced Rhythm
Discussion – Incognito Paced Rhythm Click here for a larger image At one look it looks like left bundle branch block (blue arrows – lead I and aVL). But V5 shows negative complexes which is not typical of LBBB (violet arrow). There is left axis deviation as indicated by negative complexes in the inferior leads (green arrows). PR interval can be seen as varying on scrutiny of multiple beats. But PP interval is constant (red arrows). Atrial rate is higher than the ventricular rate (PP interval shorter than RR interval). Hence the four criteria for complete heart block are satisfied: Regular PP interval Regular ...
Source: Cardiophile MD - April 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 57
Click here for a larger image Post your answer as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - April 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

3D Printed Heart from one ’ s own cells
3D Printed Heart from one’s own cells Noor N and colleagues from Tel Aviv University have successfully produced thick vascularised patches and cellularized human hearts with a natural architecture as proof of concept by 3D printing of reprogrammed omental tissue [1]. Cells collected by omental biopsy were reprogrammed to become pluripotent stem cells. They were then differentiated into heart muscle cells and endothelial cells. Extracellular matrix was processed into a personalized hydrogel. The cells were combined with hydrogels to form bioinks for parenchymal cardiac tissue and blood vessels. 3D printing of functio...
Source: Cardiophile MD - April 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Canagliflozin protects Heart and Kidneys – CREDENCE Trial
Canagliflozin protects Heart and Kidneys – CREDENCE Trial Canagliflozin is sodium–glucose cotransporter 2 (SGLT2) inhibitor used in the treatment of type 2 diabetes mellitus. CREDENCE Trial [1] has shown that Canagliflozin provides both cardiovascular and renal protection in patients with type 2 diabetes mellitus. CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial was a double blind randomized trial comparing Canagliflozin 100 mg daily with placebo in type 2 diabetes with albuminuria and chronic kidney disease. They were also treated with renin–ang...
Source: Cardiophile MD - April 15, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Reducing residual cardiovascular risk
Reducing residual cardiovascular risk in patients treated with statins and having hypertriglyceridemia was addressed by Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) [1]. REDUCE-IT was a double blind placebo controlled multicenter randomized trial. Patients with established cardiovascular disease or diabetes mellitus with other risk factors treated with statins were evaluated. At study inclusion they needed to have fasting triglyceride levels between 135 and 499 mg/dL and LDL cholesterol level 41 to 100 mg/dL. They were randomized to either 2 g of icosapent ethyl twice ...
Source: Cardiophile MD - April 15, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

GI bleed with Continuous flow LVAD – Mechanisms
GI bleed with Continuous flow LVAD – Mechanisms Gastrointestinal bleeds can occur in 15-40% of patients on continuous flow left ventricular assist devices (LVAD) for end stage heart failure. Proposed mechanisms for gastrointestinal bleeds with continuous flow LVAD includes: Acquired von Willebrand disease Impaired platelet aggregation Enhanced angiogenesis causing arteriovenous malformations (AVM) Intensity of anticoagulation AVMs may contribute to about half of the GI bleed with continuous flow LVADS. Hypoperfusion of gastrointestinal mucosa leads to angiogenesis and the new friable vessels are prone for bleeding...
Source: Cardiophile MD - April 13, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs

Better postoperative outcome with Class II indications for surgery in Aortic Regurgitation?
Are Class II indications for surgery in hemodynamically significant chronic aortic regurgitation better than Class I indications with regards to post operative outcome? So it appears according to a study by Yang LT et al, published in the Journal of American College of Cardiology [1]. According to 2014 AHA/ACC Guideline for the management of patients with valvular heart disease [2], the indications for surgery in dominant aortic regurgitation are as follows: Symptoms – Class I Left ventricular ejection fraction less than 50% – Class I Along with surgery for aortic dilatation or aneurysms – Class I...
Source: Cardiophile MD - April 12, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs

High-quality plant protein sources – legumes, soy, nuts – improve lipid profile
High-quality plant protein sources – legumes, soy, nuts – improve lipid profile Meta-analysis published in Circulation [1] evaluated randomized controlled trials comparing red meat consumption with other diets regarding cardiovascular risk factors. One of the key findings of the meta-analysis was that high-quality plant protein sources like legumes, soy and nuts resulted in more favourable changes in total and low density lipoprotein (LDL) cholesterol in comparison with red meat. So far, though epidemiological studies suggested that higher red meat consumption can lead to higher risk of diabetes mell...
Source: Cardiophile MD - April 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Out of Hospital Cardiac Arrest third leading cause of DALY
Disability Adjusted Life Years (DALY) following adult nontraumatic Out of Hospital Cardiac Arrest (OHCA) treated by Emergency Medical in the United States of America has been shown to be the third leading cause of DALY lost in the year 2016 [1]. DALY is a standardized public health measure for estimating and comparing the burden of disease to the society at large. Coute RA and associates used the data from US national Cardiac Arrest Registry to Enhance Survival database for 2016. Years of life lost was calculated from this data and the remaining life expectancy at the age of death. Cerebral performance category scores fr...
Source: Cardiophile MD - April 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ECG Quiz 56 – Discussion
Discussion Click here for a larger image QT interval is prolonged with a QTc of around 500 ms. T waves are flat in inferior and lateral leads. The speciality of QT prolongation is that ST segment is more prolonged (blue arrows) compared to width of QRS and T wave. Such ST prolongation should alert us about hypocalcemia because the effect of calcium is mainly in the plateau phase (phase 2) of the cardiac action potential and corresponds to the ST segment. In hypokalemia T wave amplitudes are reduced and U waves become prominent, causing an apparent QT prolongation.  Here prominent U waves are not seen, though T wave a...
Source: Cardiophile MD - April 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 56
Click here for a larger image Please post your discussion as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - April 9, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Visualization of stent during coronary angioplasty
Blue arrows: edges of stent; red arrows: balloon edge markers (there will be an overhang of the balloon beyond the markers on either side); yellow arrow: guide catheter; violet arrow: angioplasty guide wire. Guide catheter is in left main coronary artery, guidewire and stent in left anterior descending coronary artery. Accurate visualization of the stent position and morphology is essential for good implantation technique. Stent has to be well expanded and apposed to the vessel wall to prevent stent thrombosis. But good visualization in a moving vessel is often challenging. Selecting a good view with less of movement is ...
Source: Cardiophile MD - April 7, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Stent boost subtract imaging Source Type: blogs

Supersaturated oxygen reduces infarct size in anterior wall infarction
United States Food and Drug Administration (US FDA) has approved SuperSaturated Oxygen (SSO2) Therapy for reducing infarct size in left anterior descending coronary artery territory ST elevation myocardial infarction (STEMI) within 6 hours of onset, after percutaneous coronary intervention.  How is supersaturated oxygen delivered? Supersaturated oxygen is delivered using an extracorporeal circuit (TherOx, Inc, Irvine, Calif). Blood is withdrawn from the sidearm of the femoral sheath which is chosen to be 2F larger than the PCI guide or from a 5F sheath in the opposite femoral artery. The blood is oxygenated in a pol...
Source: Cardiophile MD - April 6, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs

Percutaneous Mitral Valve Repair
Mitral regurgitation is the commonest valvular lesion, due to aging of the population at large and degenerative valvular heart disease overtaking rheumatic heart disease. Standard treatment for symptomatic severe mitral regurgitation and asymptomatic severe mitral regurgitation with left ventricular dysfunction is surgical treatment. Among surgical treatments available, mitral valve repair has lesser morbidity than replacement if the valve is amenable for repair. Surgical treatment has to be deferred very often in this elderly population with multiple comorbidities [1]. Hence the role of percutaneous mitral valve repair ...
Source: Cardiophile MD - April 2, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Structural Heart Disease Interventions Source Type: blogs

ECG Quiz 55 – Discussion – 3:1 AV Block
Discussion – 3:1 AV Block ECG Quiz 55 – 3:1 AV Block Click here for a larger image There are three P waves for every QRS complex. Two P waves between the QRS complexes are evident while one is ‘hidden’ over the T wave. Hence this is a 3:1 AV block. At an initial look, it may be called 2:1 AV block because there are only two obvious P waves between any pair of QRS complexes. But the clue is the PP interval, which is only one third of the RR interval. Then one has to look meticulously for the ‘hidden P waves’ over the T waves. The hidden P waves may not be very evident in some leads while ...
Source: Cardiophile MD - April 2, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 55
Click here for a larger image Please click here for the discussion. (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Heart failure with false negative BNP – Cardiology MCQ – Answer
Heart failure with false negative BNP – Cardiology MCQ – Answer In which of the following conditions with heart failure can false negative BNP (B-type natriuretic peptide) values occur? Correct answer:  3. Mitral stenosis False negative BNP can occur in obesity, flash pulmonary edema (BNP elevation may be delayed) and mitral stenosis (heart failure without dilatation of left ventricle). False positive BNP can occur in old age, renal failure, myocardial infarction and cor pulmonale. Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - March 31, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Investigations and management of dilated cardiomyopathy
Investigations in dilated cardiomyopathy Chest X-ray PA view will assess the cardiac size in dilated cardiomyopathy and show evidence of pulmonary congestion. Sick persons may present with features of frank pulmonary edema in the form of hilar haze or bat wing pattern of pulmonary edema. Significant left ventricular dysfunction can exist without much of cardiomegaly on chest X-ray as well. ECG may show sinus tachycardia, left atrial overload and sometimes left ventricular hypertrophy. A wide QRS complex with left bundle branch block pattern may indicate potential benefit from cardiac resynchronization therapy (CRT). ECG ...
Source: Cardiophile MD - March 30, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Stuck on plaque in carcinoid heart disease and anorexigen associated valvular heart disease
“Stuck on plaque” is the description given to the lesions on the tricuspid valve in carcinoid heart disease and anorexigen associated valvular heart disease. The lesions appear “stuck on” the leaflets without inflammation or damage to the underlying valve structure [1, 2]. An article in NEJM (free full text) gives the image of a stuck on plaque on an excised mitral valve in fenfluramine associated valvular heart disease [3]. Histopathological section showed that the valve architecture was preserved. The plaque encased the chordae tendinae. A large surgical pathology series in Mayo Clinic...
Source: Cardiophile MD - March 30, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

ECG Quiz 54 – Discussion: Right arm – Left leg lead reversal
Discussion: Right arm – Left leg lead reversal Click here for a larger image Lead I shows inverted P waves, which in the absence of features of dextrocardia in the chest leads (regression of amplitude of QRS complexes as you move from V1-V6) should make one suspect lead reversal. But this is not the common right arm – left arm lead reversal pattern when you look at the inferior leads. At one look, the inferior leads makes you think of an evolved inferior wall myocardial infarction. But the clue is the inverted P waves in inferior leads (blue arrows). Uniform negativity of the QRS complex (violet arrows) and T ...
Source: Cardiophile MD - March 30, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Heart failure with false negative BNP – Cardiology MCQ
Heart failure with false negative BNP – Cardiology MCQ In which of the following conditions with heart failure can false negative BNP (B-type natriuretic peptide) values occur? Myocardial infarction Dilated cardiomyopathy Mitral stenosis Mitral regurgitation Post your answer as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - March 29, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

ECG Quiz 54
Please click here for a larger image Click here for the discussion (Source: Cardiophile MD)
Source: Cardiophile MD - March 28, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 53
Click here for a larger image Which is the culprit artery and why? Which classical sign is illustrated by this ECG? Please post your discussion as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - March 28, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 52 – Discussion
Discussion Please click here for a larger image In addition to sinus tachycardia, ST depression is noted in lateral leads I, aVL, V4-V6 (blue arrows). QS complexes are note in III and aVF (red arrows). Minimal ST depression is noted in lead (violet arrow). Mild ST elevation is noted in aVR (black arrow) and V1 (green arrow). Overall this ECG fits in with that of an acute coronary syndrome. ST depression is indicative of subendocardial ischemia. ST elevation aVR has been given certain added significance, probably a little more than what is needed as studies have shown ST elevation in aVR with left main coronary artery occl...
Source: Cardiophile MD - March 26, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 52
Click here for a larger image Please click here for the discussion (Source: Cardiophile MD)
Source: Cardiophile MD - March 25, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 51 – Discussion
Discussion Click here for a larger image This ECG shows a narrow QRS tachycardia at a rate of around 180/min. No P waves are seen to precede the QRS complexes. Then it has to be taken as supraventricular tachycardia. Close scrutiny of the tracing shows probable negative P waves after the QRS complex in lead II (red arrow). They are called ‘pseudo s‘ waves produced by retrograde P waves. This pattern is seen in atrioventricular nodal reentrant tachycardia (AVNRT). Here the RP is shorter than PR (from retrograde P to next R wave), qualifying for the short RP tachycardia of the slow-fast variety of AVNRT. In the ...
Source: Cardiophile MD - March 24, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 51
Click here for an enlarged view Click here for the discussion (Source: Cardiophile MD)
Source: Cardiophile MD - March 22, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

WPW Syndrome – the great mimicker
WPW Syndrome – the great mimicker WPW Syndrome the great mimicker Click here for a larger image This ECG shows sinus bradycardia with short PR interval and delta waves (black arrow in V5) indicating Wolff-Parkinson-White (WPW) syndrome. WPW syndrome is a great mimicker as shown in this ECG: Myocardial infarction: Negative delta in inferior leads (blue arrows) may be mistaken for pathological Q waves of old myocardial infarction. Right ventricular hypertrophy: Tall R waves in V1, V2 (red arrows) may be mistaken for right ventricular hypertrophy. Left ventricular hypertrophy: Tall R waves in V5 (violet arrow) may be ...
Source: Cardiophile MD - March 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG Quiz 50 – Discussion
Discussion Click here for a larger image Supraventricular ectopic beat is visible as narrow QRS complex without a preceding P wave (red arrow). PR interval of the sinus beats are at the upper limit of normal (200 ms). QR pattern (blue arrow) is seen in anterior leads, indicating old anterior wall infarction with right bundle branch block (QRBBB). This along with left anterior hemiblock (rS pattern in inferior leads) makes it an old anterior wall infarction with almost a trifascicular block. 50 Hz line voltage inference artefacts are seen as regular sine wave pattern of the baseline, especially in leads I, II, aVR and the ...
Source: Cardiophile MD - March 19, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Antibacterial envelope lowers major CIED infections
Infections related to Cardiac Implantable Electronic Devices (CIED) cause significant morbidity and mortality. Till now, only preoperative antibiotics have been shown to be a useful preventive strategy. A new study published in NEJM [1] and presented at the Annual Conference of the American College of Cardiology 2019 assessed the preventive role of an antibacterial envelope against CIED related infections. It was a randomized controlled clinical trial to assess the safety and efficacy of an absorbable antibiotic eluting envelope in reducing CIED associated infections. Those undergoing a new implant as well as those under...
Source: Cardiophile MD - March 18, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Reversal of ticagrelor – phase 1 trial of a new agent
Reversal of ticagrelor – phase 1 trial of a new agent Platelet transfusion may be ineffective in reversing the effects of the P2Y12 inhibitor ticagrelor [1]. This is because the free drug binds to fresh platelets [2]. Small reversal effect has been noted with platelet transfusion for the effect of clopidogrel [2]. Phase 1 trial of an antibody capable of reversing the antiplatelet effect of ticagrelor has been presented at the American College of Cardiology Annual Conference 2019, New Orleans, LA. PB2452, ticagrelor reversal agent, is a monoclonal antibody fragment that binds ticagrelor with high affinity. It was a p...
Source: Cardiophile MD - March 18, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ECG Quiz 50
Click on the image for a larger view Please post your discussion as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - March 18, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Wearables for detection of AF – Apple Heart Study
Wearables for detection of AF – Apple Heart Study The Apple Heart Study was an app based study using smartwatch to detect cardiac arrhythmias [1]. The preliminary findings of Apple Heart Study has been presented at the American College of Cardiology meeting 2019 at New Orleans. The study enrolled enrolled 419,297 participants over a period of just 8 months, indicating the power of social media in enrolling participants. The number comes to about 1 in 600 adults in the United States of America. Of these, 24, 626 were aged 65 years or more. Primary objective of the study was to measure the number of participants with ...
Source: Cardiophile MD - March 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ISCHEMIA Trial baseline data
International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial was sponsored by the New York University School of Medicine. Collaborators include National Heart, Lung, and Blood Institute (NHLBI), Stanford University, Duke University, Emory University, Harvard University and several other leading institutions. ISCHEMIA trial randomized 5179 patients with stable ischemic heart disease with moderate to severe degree of inducible ischemia on stress testing. Blinded CT coronary angiogram was used to exclude those with significant unprotected left main coronary artery disease or ...
Source: Cardiophile MD - March 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ECG Quiz 49 – Discussion
Discussion Click here for a larger image PP interval is half that of the RR interval. The P wave marked by red arrow is non conducted, while the P wave followed by the blue arrow is followed by a QRS complex. So it is a 2:1 AV conduction, the highest grade of second degree AV block. It is possible that longer recordings might show slight changes in P-QRS relationship so that it could even be complete AV block appearing as 2:1 AV block for a short period of time during the ECG recording. As the QRS complex is narrow, it is likely to be supra Hisian block at the AV nodal level rather than an infra Hisian block. Moreover, EC...
Source: Cardiophile MD - March 15, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Pardee's sign Source Type: blogs

ECG Quiz 49
Click here for a larger image Post your findings as a comment below and click here for the discussion (Source: Cardiophile MD)
Source: Cardiophile MD - March 14, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Perventricular VSD closure
Perventricular VSD closure  Perventricular VSD closure is a hybrid procedure in which the cardiac surgeon opens the chest and the cardiologist passes a sheath through the right ventricle to achieve a device closure of the ventricular septal defect (VSD). Hybrid procedures are done in hybrid suites with facility for both open heart surgery and radiographic equipment for cardiac catheterization and angiography (hybrid of open heart surgery theatre and cardiac catheterization laboratory or cathlab). Heart is exposed through a lower partial sternotomy. The advantage is that cardiopulmonary bypass is n...
Source: Cardiophile MD - March 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Cardiac Surgery device occluder guide wire Perventricular closure of ventricular septal defect Perventricular closure of VSD TEE guidance trans esophageal echocardiographic guidance Source Type: blogs

Hypertrophic cardiomyopathy – Cardiology MCQ
Hypertrophic cardiomyopathy – Cardiology MCQ Most common symptom in hypertrophic cardiomyopathy is: Dyspnea Angina Palpitation Syncope Post your answer as a comment below and click here for the discussion and correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - March 7, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Atrial infarction – Cardiology MCQ
Atrial infarction – Cardiology MCQ Wrong statement about atrial infarction: Left atrial infarction is more common than right atrial infarction Infarction is more common in the atrial appendages than lateral or posterior wall May be accompanied by paroxysmal atrial fibrillation PR segment depression in leads II, III Post your answer as a comment below and click here for checking the correct answer and discussion (Source: Cardiophile MD)
Source: Cardiophile MD - March 7, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Selvester QRS scoring – Cardiology MCQ
Selvester QRS scoring – Cardiology MCQ Leads NOT included in the Selvester QRS scoring for estimation of infarct size: Lead III and aVR Lead I and aVL Lead II and aVF None of the above Post your answer as a comment below and check here for the correct answer. (Source: Cardiophile MD)
Source: Cardiophile MD - March 7, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Papillary muscles – echocardiogram
Papillary muscles – echocardiogram IVS: Interventricular septum Echocardiogram from parasternal short axis view showing the two papillary muscles in the left ventricle (posteromedial and anterolateral). Papillary muscles form part of the mitral valve apparatus which prevent bulging back of the mitral leaflets during systole and thus avoiding mitral regurgitation. When the papillary muscles are ischemic and dysfunctional it results in mitral regurgitation due to papillary muscle dysfunction. If the head of the papillary muscle gets necrosed and ruptures in acute myocardial infarction, it results in acute severe mitra...
Source: Cardiophile MD - March 3, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology catheter ablation Source Type: blogs

Sleepy during daytime? Heart risk high!
The Sleep Heart Health Study [1] found that obstructive sleep apnea (OSA) with excessive daytime sleepiness triples the chance of heart failure and doubles the risk of a cardiovascular event. The study evaluated data from over 1200 patients with OSA and an apnea-hypopnea index (AHI) of 15 or more events per hour. Important symptom subtypes noted were as follows: Disturbed Sleep (12.2%) Minimally Symptomatic (32.6%) Excessively Sleepy (16.7%) Moderately Sleepy (38.5%) Excessively Sleepy subtype was associated with over 3 times increased risk of prevalent heart failure. The same subtype was associated with increased risk...
Source: Cardiophile MD - March 1, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology apnea-hypopnea index OSA OSA and cardiovascular event OSA and heart failure Source Type: blogs

Normal mitral valve cross section on echocardiography
Normal mitral valve echocardiogram in parasternal short axis Normal mitral valve cross section on echocardiography -annotated RV: Right ventricle; IVS: Interventricular septum; LVPW: Left ventricular posterior wall This parasternal short axis echocardiogram is a cross section of the left ventricle at the mitral valve level. Both anterior mitral leaflet (AML) and posterior mitral leaflet (PML) are seen well. Three scallops posterior leaflet are called P1, P2 and P3. Correspondingly anterior mitral leaflet is divided into three virtual regions: A1, A2 and A3. Scallops are best visualised by three dimensional transesophageal...
Source: Cardiophile MD - February 28, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography Source Type: blogs

Conventional CPR vs Extracorporeal CPR
Prompt initiation of cardiopulmonary resuscitation (CPR) is the key to better survival and lower morbidity after a cardiac arrest. Still survival is low even after in hospital cardiac arrest of the order of 20% while it is still lower, of the order of 10% for out of hospital cardiac arrest. “Now flow” time is the period from the onset of cardiac arrest to the initiation of chest compression. “Low flow” time is the period of conventional CPR (CCPR) till the achievement of ROSC (return of spontaneous circulation). Need for prolonged CPR reduces the survival. Need for CPR of 45 minutes or more has bee...
Source: Cardiophile MD - February 27, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Indications and contraindications for head up tilt test (HUTT)
Indications for HUTT Recurrent syncope or presyncope High risk patients with single syncopal episode: e.g. Serious injury with syncope, syncope while driving No other cause for symptoms by history, examination or cardiovascular and neurological workup Elderly patients with recurrent, unexplained falls For the differential diagnosis of: Convulsive syncope Orthostatic hypotension Postural orthostatic tachycardia syndrome Psychogenic syncope Hyperventilation syncope Carotid sinus hypersensitivity Relative contraindications for HUTT Severe left ventricular outflow obstruction Critical mitral stenosis Severe proximal c...
Source: Cardiophile MD - February 25, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – ECG Quiz
Cardiology MCQ – ECG Quiz Click here for a larger image This ECG shows: Wellens sign Pardee sign Brugada sign aVR sign Post your answer as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - February 25, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology ECG Library Source Type: blogs