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BIOTRONIK ’s New Personalizable and Energy Efficient CRTs
BIOTRONIK is releasing a new line of cardiac resynchronization therapy (CRT) implants, the Ilivia series, that are designed to improve patient response to the therapy and make it customizable for individual needs. The devices are compatible under MRI and feature the company’s MRI AutoDetect capability that automatically switches the devices to a special safe mode during an MRI scan. A problem with most CRTs is that achieving a more positive reaction from the heart often requires using more energy, thereby depleting the battery inside the implant too quickly and so necessitating extra surgeries. The Ilivia relies on B...
Source: Medgadget - February 2, 2017 Category: Medical Equipment Authors: Editors Tags: Cardiology Radiology Source Type: blogs

Very wide QRS complex
Width of the QRS complex in this ECG is about 200 ms. It is so wide that there is hardly any ST segment visible. The QRS merges into the T wave. One situation in which this occurs is severe hyperkalemia. But here the T wave are not tall and P waves are of reasonable amplitude, both against severe hyperkalemia. In severe hyperkalemia, P waves are flattened and disappear resulting in the so called sinoventricular conduction. Wide QRS in hyperkalemia merges with the tall T waves, producing a sine wave pattern, which is also absent here. Initial upstroke of the QRS is sharp in this ECG while the terminal slurring is very promi...
Source: Cardiophile MD - November 24, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology ECG / Electrophysiology ECG Library Source Type: blogs

Medtronic ’s Claria MRI Quad CRT-D SureScan with EffectivCRT Approved by FDA
Medtronic just announced that its Claria MRI Quad Cardiac Resynchronization Therapy Defibrillator (CRT-D) SureScan implant has been approved for use on patients with heart failure. The “MRI” in the name of the device indicates that its safe for magnetic resonance scanning in both 1.5 and 3 Tesla machines, given certain precautions. The device features the firm’s EffectivCRT algorithm that assesses the outcome of each stimulation of the left ventricle and adjusts therapy accordingly. Because a lot of people treated with CRT-D’s suffer from atrial fibrillation, the effectiveness of the therapy is ofte...
Source: Medgadget - November 14, 2016 Category: Medical Equipment Authors: Editors Tags: Cardiology Source Type: blogs

BIOTRONIK Releases Most Powerful Implantable Cardioverter Defibrillator in U.S.
BIOTRONIK is releasing the world’s most powerful implantable cardioverter defibrillator (ICD) in the United States. The Inventra HF-T cardiac resynchronization therapy defibrillator (CRT-D) can deliver 42 joules of energy in one punch to jolt even difficult to manage hearts back into a proper rhythm. Most ICDs generate about 36 joules of energy, but larger hearts and those with a reduced ejection fraction may need a stronger shock to get their arrhythmia under control. The Inventra HF-T sends 42 joules immediately on the first shock, potentially able to save the lives of more patients on CRT-D therapy. The implant...
Source: Medgadget - November 7, 2016 Category: Medical Equipment Authors: Editors Tags: Cardiac Surgery Cardiology Source Type: blogs

Ablation better than amiodarone for persistent AF with congestive heart failure
AATAC Multicenter Randomized Trial [1] has demonstrated that catheter ablation is clearly superior to amiodarone for heart failure and persistent atrial fibrillation having an implanted device. The study involved about two hundred patients with dual chamber defibrillator or cardiac resynchronization therapy and left ventricular ejection fraction less than 40% with functional class of New York Heart Association II or III. The primary endpoint was recurrence of atrial fibrillation while secondary endpoints were all cause mortality and unplanned hospitalization. All the endpoints were better in the catheter ablation group com...
Source: Cardiophile MD - April 28, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

A Patient with Ischemic symptoms and a Biventricular Pacemaker
This case was sent by Gary Giorgio from Summa Health Emergency Medicine Residency in Akron, Ohio. He frequently sends very interesting cases.Background:There are many who say that STEMI cannot be diagnosed in the setting of a ventricular paced rhythm. In a recent survey, as part of a case posted on Medscape by my mentor, K. Wang, 48% of respondants answered that "One cannot diagnose an infarction from ventricularly paced complexes."CaseAn elderly woman presented with 6 hours of arm, back, jaw pain, diaphoresis, and dyspnea (no chest pain!). There was an unclear history of CAD as previous care w...
Source: Dr. Smith's ECG Blog - April 1, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 19
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 19. You scored %%SCORE%% out of %%TOTAL%%. Your performa...
Source: Cardiophile MD - February 25, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 10
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 10. You scored %%SCORE%% out of %%TOTAL%%. Your performa...
Source: Cardiophile MD - February 1, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 8
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease. This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - January 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs

Briefly without pulse, has pulmonary edema and LBBB with 10 mm of ST Elevation
A middle-aged male was found down. EMS was able to get the patient to climb onto the ambulance by himself, then during transport he became less responsive. They briefly could not find pulses, and gave a short period of CPR with ROSC, but he did not require a shock. They gave Narcan without improvement. An oral airway was placed and BVM oxygenation provided. The patient arrived unable to provide any further history.BP was 180/100, HR 130, Oxygen saturations 84%.He was intubated. A bedside ultrasound showed poor global function and B-lines of pulmonary edema.Here was the first ECG:There is sinus...
Source: Dr. Smith's ECG Blog - December 13, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Physiological Interventricular de-synchrony : Right ventricle contracts like an Intestine !
Right ventricle,being a venous chamber has distinct anatomical and physiological features to carry out this function.RV has a complex shape, its triangular in long axis and crescent like in short axis , thin (<5mm) more distendable .Contraction of RV begins slightly early but ends later than LV (30ms ) https://www.youtube.com/watch?v=GH5trHYjozI RV receives blood from RA and ejects in to PA in a sequential manner .The inflow, body and outflow contract somewhat like intestinal peristalsis. This is facilitated by the incremental delay in the electrical depolarization of right ventricle.In physiological condi...
Source: Dr.S.Venkatesan MD - May 5, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Right ventricle best articles on right ventricle cardiac peristalsis physiological inter ventricualr desynchrony Right ventricle anatomy and physiology right ventricular sequential peristaltic contraction Source Type: blogs

Cardiac resynchronization therapy (CRT)
Brief Review Abstract: Cardiac resynchronization therapy (CRT) is biventricular pacing in which one lead paces the right ventricle endocardially, another the left ventricle epicardially through a coronary vein and a third paces the right atrial appendage. It is a mode of treatment of left ventricular failure due to cardiac dyssynchrony, usually with left bundle branch block and wide QRS complex. X-ray Chest in CRT showing pulse generator and three leads Pulse generator is seen in the left infraclavicular region with three leads connected. One lead is seen free behind the pulse generator, possibly an earlier right ventric...
Source: Cardiophile MD - January 26, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

Cardiac resynchronization therapy (CRT) – X-ray
Brief Review Abstract: Cardiac resynchronization therapy (CRT) is biventricular pacing in which one lead paces the right ventricle endocardially, another the left ventricle epicardially through a coronary vein and a third paces the right atrial appendage. It is a mode of treatment of left ventricular failure due to cardiac dyssynchrony, usually with left bundle branch block and wide QRS complex. X-ray Chest in CRT showing pulse generator and three leads Pulse generator is seen in the left infraclavicular region with three leads connected. One lead is seen free behind the pulse generator, possibly an earlier right ventricu...
Source: Cardiophile MD - January 26, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

Coronary sinus atresia
Brief Review Abstract: Coronary sinus atresia is usually a congenital anomaly. Sometimes it is acquired, due to an AV fistula involving the middle cardiac vein which becomes grossly enlarged and impinges on the coronary sinus ostium and closes it off. Congenital atresia of the right atrial ostium of the coronary sinus can lead to different pathways for drainage of coronary venous outflow. In some cases, coronary venous outflow may move through a persistent left superior vena cava into the left brachiocephalic vein. From the left brachiocephalic vein it reaches the right atrium through the right superior vena cava.1,2 In...
Source: Cardiophile MD - January 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Cardiology MCQ: Selvester QRS scoring
Leads not included in the Selvester QRS scoring system: a) Lead I and aVL b) Lead II and aVF c) Lead III and aVR d) None of the above Correct answer: c) Lead III and aVR Selvester QRS scoring system is a 50 criteria 31 point QRS scoring system which was developed for estimating the infarct size from ECG. Each point on the scoring system will account for about 3% of left ventricular myocardium. The scoring system used 10 of the standard 12 leads with weighting for each criteria ranging from 1 to 3 points. Lead III and aVR are not included in this scoring system. Maximum points that can be taken from each lead are as follo...
Source: Cardiophile MD - November 25, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs