What is domino heart transplantation?
In domino heart transplantation, the donor receives heart lung transplantation. The excised heart is transplanted to another recipient so that the donor for recipient of domino heart transplantation is alive, unlike the conventional donor who is brain dead.
In one report of 10 cases of domino heart transplantation, one year survival of donor was 60% while that of recipient was 90% [1]. It worthwhile noting that donors had terminal cardio pneumopathy (mostly primary pulmonary hypertension, one case of Eisenmenger syndrome and one each of cystic fibrosis, bronchiectasis, and bronchiolitis obliterans) while recipi...
Source: Cardiophile MD - November 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Bayes Syndrome?
Bayes Syndrome is third degree interatrial block with paroxysmal supraventricular arrhythmias.
Various degrees of interatrial blocks are identified as follows:
First degree interatrial block: P wave duration more than 120 ms
Third degree interatrial block: Longer P wave duration with biphasic P waves in inferior leads
Second degree interatrial block: These abnormalities are seen transiently in same ECG (atrial aberrancy)
It may be noted that these abnormalities may occur with or without associated atrial enlargement detectable by imaging modalities.
References
Bayés de Luna A, Platonov P, Cosio FG, Cygankiewicz I, Pas...
Source: Cardiophile MD - November 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Door in – Door Out Time?
What is Door in – Door Out Time?
Door in door out time is applicable when a person presents with ST segment elevation myocardial infarction to a centre which does not have the facility to perform primary angioplasty by percutaneous coronary intervention or PCI.
Recommended door in – door out time in ST elevation myocardial infarction presenting to non-PCI capable center is less than 30 minutes. Primary angioplasty being the best option to open up the infarct related coronary artery, it has to be done at the earliest. So time should not be lost by undue observation at a non PCI capable centre. When the person presen...
Source: Cardiophile MD - November 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the role of Disopyramide in HCM?
Disopyramide is a class Ia antiarrhythmic agent which can be used in hypertrophic obstructive cardiomyopathy when beta blockers alone are ineffective. Disopyramide has a negative inotropic action and is useful in reducing left ventricular outflow tract gradients in hypertrophic obstructive cardiomyopathy and does not increase the risk of sudden cardiac death. Dose reduction is recommended when QTc exceeds 480 ms. It should be avoided in those with glaucoma and men with prostatic symptoms in view of its anticholinergic action. Anticholinergic action is responsible for increase in ventricular rate with atrial fibrillation. ...
Source: Cardiophile MD - November 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Abnormal exercise blood pressure response in HOCM
Abnormal exercise blood pressure response in hypertrophic obstructive cardiomyopathy has been defined as failure to rise at least 20 mm Hg or fall of at least 20 mm Hg from peak level. Please note that exercise testing in HOCM could be risky and needs due precautions.
Abnormal exercise blood pressure response in hypertrophic obstructive cardiomyopathy has been associated with increased risk of sudden cardiac death in younger individuals below the age of 40 years. Progressive increase in blood pressure upto peak exercise is the normal physiological response to exercise.
Reference
1. Elliott PM, Anastasakis A, Borger M...
Source: Cardiophile MD - November 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Which type of beta blocker is not ideal for HOCM?
Vasodilating beta blockers are not an ideal choice for the treatment of hypertrophic obstructive cardiomyopathy.
Non vasodilating betablockers are recommended for the treatment of hypertrophic obstructive cardiomyopathy (Class I, Level of Evidence B, as per European Society of Cardiology Recommendations 2014). Other class I drug recommendation when beta blockers are not tolerated is verapamil. Disopyramide has a class I recommendation in combination with betablocker or verapamil.
Reference
1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna W...
Source: Cardiophile MD - November 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Morrow procedure?
Ventricular septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) is otherwise known as Morrow procedure.
In Morrow procedure, a rectangular trough is created in the basal left ventricular septum from below the aortic valve to a point beyond the point of contact of the anterior mitral leaflet to the septum (point of SAM septal contact). It is the procedure of choice for symptomatic drug refractory HOCM, provided it is done in centers with adequate experience with the procedure.
Reference
1. Morrow AG, Reitz BA, Epstein SE, Henry WL, Conkle DM, Itscoitz SB, Redwood DR. Operative treatment in hypertrophic subao...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can digoxin be given in hypertrophic cardiomyopathy?
Low dose digoxin can be used to control ventricular rate in those with left ventricular ejection fraction less than 50%, having NYHA class II-IV symptoms and permanent atrial fibrillation (Class IIb, level of evidence C, 2014 European Society of Cardiology Guidelines)
Being an inotropic agent digoxin can enhance the left ventricular outflow tract obstruction. Even in those without LVOT obstruction, digoxin is not recommended, except in the specific subset mentioned above, that too only as a Class IIb recommendation.
Reference
1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, L...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Sudden cessation of cerebral blood flow causes syncope in how many seconds?
Sudden cessation of cerebral blood flow causes syncope in 6-8 seconds.
A fall of systolic blood pressure to 50–60 mmHg at the level of the heart, which corresponds to 30–45 mmHg at the level of the brain in the upright position can also cause syncope with complete loss of consciousness.
Syncope is defined as transient loss of consciousness due to cerebral hypoperfusion, which has a rapid onset, short duration and complete recovery.
Reference
1. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG; ES...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the commonest sustained arrhythmia in HCM?
Commonest sustained arrhythmia in hypertrophic cardiomyopathy is atrial fibrillation. Atrial fibrillation (AF) can occur in about 1/5th of cases of hypertrophic cardiomyopathy (HCM). Factors predisposing to AF in HCM are left atrial pressure and size due to left ventricular diastolic dysfunction, left ventricular outflow tract obstruction and mitral regurgitation. About one fourth of them may develop embolic episodes and stroke. It has been suggested that those with left atrial diameter of 45 mm or more should undergo 48 hour Holter once or twice a year to look for AF. Anticoagulation is recommended in those with AF ...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
High risk features in the history of a syncopal event
Some features in history of syncope indicating a high risk of cardiac origin are:
Associated with new onset of chest discomfort or breathlessness
Syncope during exertion or while supine
Sudden onset palpitation soon followed by syncope
Syncope which occurs after prolonged standing or in crowded or hot places indicates reflex syncope as the most likely possibility. Other associated features for a low risk syncope are being triggered by cough, defecation or micturition, during a meal or post prandial, after sudden unexpected unpleasant sight, sound, smell or pain and while getting up from supine or sitting position.
Refer...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Important risk factors for aortic dissection
Most common risk factor for aortic dissection in the International Registry of Acute Aortic Dissection (IRAD) was hypertension. Hypertension was noted in 76.6% in the IRAD, while Marfan syndrome was noted only in 4.4% and diabetes mellitus in 7.8%. Twenty year data from IRAD has been published. It is a study involving over 7300 cases from over 51 sites in 12 countries. Two thirds were type A dissection and one third type B. Two thirds were men and the mean age was 63 years. In general type A cases underwent surgery and type B cases underwent endovascular repair. There has been a decrease in overall in hospital mortality i...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is paroxysmal nocturnal dyspnea?
In paroxysmal nocturnal dyspnea, patient wakes up with breathlessness and sits up or even stands. It is relieved over a few minutes. Paroxysmal nocturnal dyspnea is different from orthopnea which occurs soon after assuming the supine position and is relieved by sitting up. Orthopnea has no relation to sleep. Onset of paroxysmal nocturnal dyspnea is delayed after onset of sleep as it takes some time for the peripheral edema fluid to get absorbed and translocate to the lungs. PND usually occurs 2 – 4 hours after onset of sleep. Sympathetic withdrawal during sleep is also a proposed mechanism. Paroxysmal nocturnal dyspnea ...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Which is the most commonly monitored ECG lead?
Lead II is used for continuous monitoring because it gives a good P wave and a reasonable QRS complex for fair delineation of rhythm abnormalities.
If ST segment monitoring in acute coronary syndrome is the aim of monitoring, V5 may be a better lead as ST shifts are often well seen in chest leads. In inferior leads the amplitude of ST shifts are generally lower.
It is always a good practice to look at the baseline ECG to choose which lead to monitor in each person. If lead II is almost equiphasic in the given person, monitoring lead II may give a lot of false ‘asystole’ alarms and cause ‘alarm fatigue’ for the sta...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Ebstein ’s anomaly?
What is Ebstein’s anomaly?
Ebstein’s anomaly is characterised by the distal displacement of the septal and posterior leaflets of the tricuspid valve. The anterior leaflet is not displaced and hence is quite large and sail like. Closure of the large anterior tricuspid leaflet produces the ‘sail sound’ characteristic of Ebstein’s anomaly. The distal displacement of the tricuspid valve causes atrialization of a portion of the right ventricle. (Source: Cardiophile MD)
Source: Cardiophile MD - November 21, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
