Micro and Nanoplastics and Cardiovascular Events – Recent Study
Use of plastics in daily life is currently on the increase and it is a well known pollutant in our water bodies like rivers, ponds, lakes and ocean. Plastics can be degraded into microplastics which are smaller than 5 mm and nanoplastics which are smaller than 1000 nanometer [1]. Microplastics and nanoparticles can trigger toxicologic effects in the body [2]. Both microplastics and nanoplastics can enter our body through ingestion, inhalation and even by topical exposure on the skin. According to a webpage from United States National Oceanic and Atmospheric Administration (NOAA), microbeads which are a type of microplastic...
Source: Cardiophile MD - March 8, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Echocardiogram in Rheumatic Mitral and Aortic Regurgitation
Transcript of the video: This is an apical five chamber view and this is an apical four chamber view. You can see four chambers – RV, LV, RA, LA, and the transducer location is here. And this is five chamber because, in addition you are seeing the aorta also. Right atrium has not been labelled. In this view, you can see that mitral leaflets are thickened. This is anterior mitral leaflet, thickened, and in the closed position of mitral valve, when there should be no flow to the left atrium, you are seeing a jet, a mosaic jet, which has been traced out. Multi-coloured jet due to high velocity and turbulence. That is wh...
Source: Cardiophile MD - March 6, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Higher Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation Noted After Spinal Cord Injury
There are several factors which increase the risk of cardiovascular disease in survivors of spinal cord injury. They have a greater prevalence of obesity, dyslipidemia, metabolic syndrome and diabetes mellitus. Energy expenditure is lesser both due to lack of motor function and lack of opportunities to engage in physical activity. Autonomic dysfunction caused by spinal cord injury is associated with abnormalities in blood pressure, heart rate variability, arrhythmias and blunted cardiovascular response to exercise which can limit the capacity to perform physical activity [1]. A recent large study from Korea compared over 5...
Source: Cardiophile MD - February 27, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Left Ventricular Noncompaction
Left ventricular noncompaction is an incidental echocardiographic finding in some while others may be symptomatic. In left ventricular noncompaction, there is a thin subepicardial compact layer and a thick subendocardial layer which is non-compact and has prominent trabeculations and recesses between the trabeculae. Blood flow into and out of these recesses can provide a spectacular view on colour Doppler echocardiography, almost looking like flames of fire near the apex, in the apical four chamber view. When non-compaction is associated with left ventricular dysfunction it is called left ventricular non-compaction cardiom...
Source: Cardiophile MD - February 26, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Phenotypes in Arrhythmogenic Cardiomyopathy
Arrhythmogenic Cardiomyopathy was better known as Arrhythmogenic Right Ventricular Dysplasia or ARVD and sometimes as Arrhythmogenic Right Ventricular Cardiomyopathy or ARVC earlier. When left ventricular [1] and biventricular involvement became increasingly recognized, the terminology has been revised to Arrhythmogenic Cardiomyopathy. A study published in JACC has compared the phenotypic expression and clinical outcomes in patients with arrhythmogenic cardiomyopathy [2]. Of the 446 patients, 44% had arrhythmogenic right ventricular cardiomyopathy, while 23% had arrhythmogenic left ventricular cardiomyopathy. 33% had bive...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Fontan Fenestration: To do or not to do?
Leaving a fenestration in the interatrial septum during a Fontan repair is useful in relieving the central venous congestion when pulmonary blood flow is driven by venous pressure in Fontan repair. Data from a multicenter Pediatric Heart Network has been published in JACC: Advances [1]. Subjects were between 2-6 years at Fontan surgery done between 2010 and 2020 with cardiac catheterization done within 1 year prior to the surgery. Fenestration was done in 465 of the 702 patients. Interestingly placement of fenestration was associated with center and Fontan type – whether it was lateral tunnel or extra cardiac. Shorte...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery General Cardiology Source Type: blogs

Fetal aortic valvuloplasty
is considered for fetuses with severe valvar aortic stenosis and echocardiographic features suggesting a risk of progression to hypoplastic left heart syndrome. Though surgical options are available for infants with hypoplastic left heart syndrome, morbidity and mortality are high. So if progression to hypoplastic left heart syndrome can be prevented by fetal aortic valvuloplasty, that would be theoretically a great boon. But centers which offer fetal aortic valvuloplasty are very few and cases suitable for fetal aortic valvuloplasty are quite rare. Hence there is difficulty in attaining good case volumes for optimal proc...
Source: Cardiophile MD - February 22, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Structural Heart Disease Interventions Source Type: blogs

Role of ultrahigh-spatial-resolution photon-counting CT in assessment of coronary artery disease
I had posted about photon counting CT which  converts X-rays directly to electronic signals unlike conventional CT which converts X-rays first to light and then to electronic signals. Direct  conversion allows low energy photons to be differentiated from electronic noise. When data is acquired directly from photons of different energy levels, better contrast-to-noise ratio can be realized. Photon-counting-detector CT also improves spatial resolution. A study published in Radiology, the flagship journal of the  Radiological Society of North America evaluated both in vivo and in vitro coronary stenosis using ultrahigh-sp...
Source: Cardiophile MD - February 22, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Greater Benefit for Women with Leisure Time Physical Activity
It is well known that regular physical activity can reduce cardiovascular and all-cause mortality. Female individuals usually lag behind male individuals in exercise programs. But a study involving over four hundred thousand adults in the United States of America showed that women derive greater gains in all-cause and cardiovascular mortality risk reduction from equivalent levels of leisure-time physical activity [1]. The study had nearly 5 million person-years of follow up. Regular leisure-time physical activity was associated with 24% lower risk of all-cause mortality in females while the corresponding figure for males w...
Source: Cardiophile MD - February 20, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

ARCADIA Trial on Atrial Cardiopathy and Stroke
In an earlier post on Embolic Stroke of Undetermined Source (ESUS), I had mentioned about ARCADIA trial (AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke) which was testing whether there is role for apixaban compared to aspirin for prevention of recurrent stroke in ESUS. The trial was sponsored by the National Institutes of Health, United States of America and the results have been published in February 2024. ARCADIA trial showed that in patients with cryptogenic stroke and atrial cardiopathy, apixaban did not reduce the risk of recurrent stroke compared with low dose aspirin. The study wa...
Source: Cardiophile MD - February 19, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Potential options for reducing cardiotoxicity of anthracyclines
What are the potential options for reducing cardiotoxicity of anthracyclines? Anthracyclines are an important group of medications useful in the treatment of solid tumours and hematological malignancies. An important limitation is their potential cardiotoxicity which can cause heart failure at varying time intervals, even decades later. Some methods which have been used to prevent cardiotoxicity are longer infusion times, use of liposomal preparations, dexrazoxane, beta blockers and renin-angiotensin system inhibitors, all with different success rates. These strategies have not been universally accepted as useful modalitie...
Source: Cardiophile MD - February 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Requirements for Re-entry
These are the basic requirements for re-entry in cardiac electrophysiology: The impulse should re-excite the same area again and again repeatedly The impulse should find the same area excitable when it reaches back The area should have sufficient time to recover The impulse should be constrained or directed to reach back to the same area (Source: Cardiophile MD)
Source: Cardiophile MD - February 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology General Cardiology Source Type: blogs

What is 3D Rotational Angiography?
Some experiments of rotational angiography were going on decades back. Sometimes it would even end up in ventricular fibrillation due to prolonged injection of contrast which deprives myocardium of oxygenated blood. 3D rotational angiography is not that old technique, but a novel technology which can create a volumetric data set of contrast-enhanced CT like images with excellent visualization of soft tissues and airway, with spatial resolution even better than multi-detector CT or cardiac magnetic resonance imaging [1]. The single plane C-arm flat panel detector which we see in most cathlabs now-a-days, rotates around the ...
Source: Cardiophile MD - February 17, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Ultrafast Ultrasound Imaging
(Source: Cardiophile MD)
Source: Cardiophile MD - February 17, 2024 Category: Cardiology Authors: Johnson Francis Tags: Echocardiography Source Type: blogs

What is Ultrafast Ultrasound Imaging?
Ultrasound techniques currently used in echocardiography uses frame rates from 30-150 frames/s. This limits its temporal resolution for very short lived events, especially in pediatric and congenital heart disease with faster heart rates compared to adults [1]. While conventional ultrasound uses focused beam transmission, ultrafast ultrasound uses unfocused plane-wave ultrasound which can result in very high temporal resolution with frame rates up to 100 times faster [2]. Potential lower spatial resolution while using plane-wave is taken care of by using multiple plane-waves transmitted at slightly different angles with a ...
Source: Cardiophile MD - February 16, 2024 Category: Cardiology Authors: Johnson Francis Tags: Echocardiography Source Type: blogs