Clinical Examination of Cardiovascular System For Medical Students
Discussion on blood pressure is not included here as a separate topic is dedicated to it.
Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate.
Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may...
Source: Cardiophile MD - May 30, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can Radial Artery be Used as Conduit for CABG After Transradial Coronary Angiography?
Radial artery is being increasingly used as a conduit for coronary artery bypass grafting in multi-vessel coronary artery disease as it provides superior long term patency rates compared to saphenous vein grafts [1]. Radial artery is also increasingly being used as access point for coronary angiography and percutaneous coronary interventions. Concerns have been raised regarding the use of radial artery as conduit after transradial procedures as there is likelihood of vascular trauma during the procedures.
Some authors even mention that prior transradial catheterization is a contraindication for the use of radial artery fo...
Source: Cardiophile MD - May 8, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Cardiac Surgery Coronary Interventions General Cardiology Source Type: blogs
Off and on chest pain for 24 hours in a 50s year old man
Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell MeyersA man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath. His pain was initially mild, then became severely worse several hours prior to presentation, but then eased off again and was minimal on arrival. There was no associated diaphoresis, nausea, vomiting, arm pain, jaw pain, syncope, lightheadedness or other acute symptoms.Initial vitals: Temp 36.7 C, BP 161/79, RR...
Source: Dr. Smith's ECG Blog - April 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Which is the Ideal site to ablate VT circuit ?
Management of recurrent ventricular tachycardia has developed a lot in recent times. Anti-arrhythmic drugs(AADs) were a cornerstone for recurrent and refractory VTs .Surgeries including CABG, repair of the aneurysm, and subendocardial resection has helped to control many post-MI ischemic VTs. Soon they became obsolete. Realistically, PCIs had little impact on post-MI VT for some unknown reasons. However, with the advent of ICDs and RF, ablation, a new dimension is added to this field.
ICDs, though an attractive device, don’t prevent a VT but vow to nullify the consequence of VT. This is problematic. ICDs in spit...
Source: Dr.S.Venkatesan MD - January 12, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Missing links in IHD : What is the relationship between Ischemia & cardiac arrhythmias ?
The term Ischemic heart disease (IHD) was once very popular, but many abandoned it as it became an academic cliche. CAD & CAHD are the other terms that are equally popular and prevalent. Stable IHD was in vogue till recently, which was again replaced by “chronic coronary syndrome’ now. Honestly, I feel the original term IHD to be restored however outdated it may look. it encompasses the entire spectrum of clinical cardiac disorders.
Manifestation of Ischemia heart disease
Angina
Infarction
Cardiac failure
Arrhythmias
Silent ischemia
Sudden cardiac death
The ...
Source: Dr.S.Venkatesan MD - January 5, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions Cardiology-Arrhythmias Relationship between Ischemia and arrhytmias Source Type: blogs
A man in his 70s with chest pain
Case submitted by Rachel Plate MD, written by Pendell MeyersA man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He also noted a bilateral " odd feeling " in his arms. He stated it was similar to prior heart attacks. He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia. Here is his triage ECG:PM Cardio version:With no other information at all, I sent this ECG to Dr. Smith, who replied: " I think it is real. V3. STD in V4-5 too. "What he means is: he thinks the signs of inferior ...
Source: Dr. Smith's ECG Blog - November 23, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?
ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.===================================MY Comment, by KEN GRAUER, MD (11/5/2022):===================================Our thanks to Drs. El-Baba and McLaren — for their presentation in today’s post about an important topic worthy of our periodic reminders. We’ve presented many variations on this theme on...
Source: Dr. Smith's ECG Blog - November 4, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.
I was reading EKGs on the system and saw this one.....What did I put in as my interpretation?Interpretation: " Acute LAD occlusion until proven otherwise. " There is non-diagnostic ST Elevation in V1-V3, with rather large T-waves but in the context of a deep S-wave (high voltage). HOWEVER,lead V4 is diagnostic of OMI. This is massive ST Elevation, huge hyperacute T-wave, and loss of S-wave (which in V4, unlike V2-3,can be normal but should greatly raise suspicion.) There is ST depression in V5-6. This alone could be due to LVH, but V4 could NOT be due to LVH.There was an EKG from 5 years prior:...
Source: Dr. Smith's ECG Blog - November 1, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
What is myocardial stunning and hibernation? Cardiology Basics
Just as you can get stunned for some time if hit on the head, part of the myocardium can also stop functioning following transient coronary obstruction. This usually occurs following a myocardial infarction after which the occluded coronary artery gets opened up spontaneously or by thrombolytic therapy or primary angioplasty.
After a variable period of time, the stunned myocardium usually recovers full function. During the period of stunning, if a large part of myocardium is involved, the person may have features of heart failure due to decreased left ventricular systolic function. Myocardial stunning is the reason for he...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the types of myocardial infarction? Cardiology Basics
World Heart Federation along with major European and North American Heart Societies have brought forth the universal definition of myocardial infarction. It has been revised the fourth time in 2018. In the latest revision myocardial infarction has been classified into 5 types, of which type 4 has three subtypes as well.
Type 1 is the type of myocardial infarction which all of us are familiar with. It occurs due to sudden occlusion of a coronary artery. This leads to chest pain and ECG changes. Myocardial damage can be noted on echocardiography as well as other imaging modalities like cardiac magnetic resonance imaging (CM...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a myocardial bridge? Cardiology Basics
Normally the coronary arteries are located outside the myocardium. Occasionally a segment of the coronary artery passes through the myocardium. This causes a narrowing of that region in systole and is known as myocardial bridging. Myocardial bridging can be recognized as narrowing of a region of the coronary artery in systole which normalizes in diastole.
Usually myocardial bridges do not cause myocardial ischemia as normally the blood flow into the myocardium occur mostly during diastole. Still myocardial bridges can rarely cause myocardial ischemia and cause chest pain. Rarely this may need recurrent hospital admi...
Source: Cardiophile MD - October 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a nuclear stress test? Cardiology Basics
Usual stress test for the evaluation of coronary artery disease is a treadmill exercise ECG. It is commonly part of general health check-up and is widely available. But there are certain situations when the exercise ECG is not interpretable as in a person with left bundle branch block. Then a nuclear stress test will be useful.
While exercise ECG tells you that there is a probability of obstructions in coronary arteries, it most often does not identify the region of myocardium supplied by the obstructed vessel.
Nuclear stress test will tell you which is the region of myocardium that is affected. If there is already signif...
Source: Cardiophile MD - October 9, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Chest pain one day after a negative stress test
Discussion Points:The patient ’s ECG transmitted to ED providers by EMS showed T waves that are easily confused with the peaked T waves of hyperkalemia. Sometimes hyperacute T waves have this slimmer, taller appearance, and it can be difficult to distinguish them in these cases. The new STE in anterior leads helps to understan d these as hyperacute. Also, other signs of hyperkalemia were absent, as there was no P wave flattening or QRS broadening, bradycardia, new AV blocks or NSIVCD, bizarre QRS morphology, or Brugada patterning. Additionally the clinical context was clearly ACS in this case, and if there were remaining...
Source: Dr. Smith's ECG Blog - October 3, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Contrasting results of REDUCE-IT and STRENGTH trials of Omega 3
Contrasting results of REDUCE-IT [1] and STRENGTH [2] trials of Omega 3 fatty acid preparations have caught the attention of scientific community. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester was evaluated in REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial). In STRENGTH trial carboxylic acid formulation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were used.
REDUCE-IT was a multicenter, randomized, double blind, placebo controlled trial. Patients enrolled had established cardiovascular disease or diabetes with other risk factors. They were rece...
Source: Cardiophile MD - September 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Wellens ’ syndrome?
What is Wellens’ syndrome?
The original description of Wellens’ syndrome dates back to 1982 in which they identified a subgroup of patients admitted with unstable angina who are at high risk of development of an extensive anterior wall myocardial infarction. These patients with critical stenosis high in the left anterior descending coronary artery, had characteristic ST-T segment changes in the precordial leads on or shortly after admission. They noted this finding in 26 of their 145 patients admitted because of unstable angina. In spite of symptom control with nitroglycerine and beta blockade, 12 of the 16 pat...
Source: Cardiophile MD - September 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
