Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia
An elderly man collapsed. There was no bystander CPR. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD.He was unidentified and there were no records availableAfter 7 shocks, he was successfully defibrillated and brought to the ED.Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines.Here is the initial ED ECG. What do you think?Rhythm: Residents asked me why it is not VT. If you use calipers (or equvalent), it is clear that the rhythm...
Source: Dr. Smith's ECG Blog - April 2, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why ICDs are less effective in Non Ischemic DCM ?
We wish, our understanding about cardiac contractile physiology is deep and nearly complete. Heart is an irreversibly coupled electro-mechanical organ , right from the fetal days until the final heart beat. In myocardial pathology, the genesis and sustainability of ventricular arrhythmia are intricately related to the degree of LV dysfunction of any cause.
SCD is the leading cause of mortality in heart failure. Tackling SCD was in God’s domain, until the brilliance of Dr. Michel Mirowski shrunk the defibrillator and implanted it under the chest in 1980. (Dr. MM’s s a unique and inspiring story, from Poland a...
Source: Dr.S.Venkatesan MD - February 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized crt device crt-p vs crt-d danish trial ischemic dcm madit trial non ischemic dcm Source Type: blogs
In Short About Idiopathic dilated cardiomyopathy
(Source: Cardiophile MD)
Source: Cardiophile MD - February 3, 2024 Category: Cardiology Authors: Johnson Francis Tags: Cardiomyopathy Source Type: blogs
Idiopathic dilated cardiomyopathy
Idiopathic dilated cardiomyopathy is a form of dilated cardiomyopathy with unknown etiology characterised by progressive left ventricular dilatation and systolic dysfunction. Pathologically, there is increase in the size and weight of the heart. There is ventricular dilatation with near normal wall thickness. The myocardial systolic dysfunction is out of portion to the fibrosis.
The incidence of idiopathic dilated cardiomyopathy varies from 3-10 cases per 100,000 population. Death from progressive pump failure occurs at the rate of about 25% in first year, 35-40% in two years and upto 40-80% over five years. Stabiliz...
Source: Cardiophile MD - December 15, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Fight Aging! Newsletter, September 11th 2023
This article reviews the current regulatory role of miR-7 in inflammation and related diseases, including viral infection, autoimmune hepatitis, inflammatory bowel disease, and encephalitis. It expounds on the molecular mechanism by which miR-7 regulates the occurrence of inflammatory diseases. Finally, the existing problems and future development directions of miR-7-based intervention on inflammation and related diseases are discussed to provide new references and help strengthen the understanding of the pathogenesis of inflammation and related diseases, as well as the development of new strategies for clinical interventi...
Source: Fight Aging! - September 10, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
DNA Damage and Consequent Inflammation in Heart Failure
One of the ways in which cell damage characteristic of aging can provoke inflammation is via the mislocalization of DNA. Either nuclear DNA or mitochondrial DNA can find its way to the cytosol, where it can trigger responses evolved to detect bacterial or viral infection, or severe cell damage. This creates a cascade of downstream signaling leading to an inflammatory response. In youth these events occur comparatively rarely, and in circumstances wherein immune response and potentially even cell death are beneficial. With age, however, there is a continued mild but growing level of dysfunction and consequent sustained infl...
Source: Fight Aging! - September 8, 2023 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
New ESC 2023 Cardiomyopathy guidelines: Truths trail by 17 years!
It was 2006
Allow me to recount an unassuming piece of a PowerPoint presentation from my institute, Madras Medical College, at the annual Cardiological Society meeting in New Delhi. The paper was categorized under miscellaneous sessions. I vividly remember the day. I have to admit, It was a nearly empty hall E, located in the basement of Hotel Ashoka. After the talk, I looked up to find that neither the chairman nor the handful of kind academic souls had any questions or comments to make. Pausing for a few moments, I quietly walked down the podium with an inexplicable silent pain.
The title of the presentation was &#...
Source: Dr.S.Venkatesan MD - August 27, 2023 Category: Cardiology Authors: dr s venkatesan Tags: cardiomyopathy Dilated cardiomyopathy hypertrophic cardiomyopathy ischemic cardiomyopathy Uncategorized drsvenkatesan ESC 2023 new cardiomyopathy guideline ndlvc non dilated cardiomyopathy Source Type: blogs
What is Mitochondrial Cardiomyopathy?
Mitochondria have two genomes – mitochondrial and nuclear. Mitochondrial disease could be due to mutations of nuclear or mitochondrial DNA. Mitochondrial DNA is inherited maternally while nuclear DNA has Mendelian inheritance, which could be dominant or recessive [1]. It may be noted in about one in 5000 live births. Cardiac involvement in mitochondrial disease seldom occurs in isolation and is often part of multiorgan dysfunction [2]. Mitochondria being part of the cellular respiratory chain, tissues with high energy requirements like heart, muscle, kidneys and endocrine system are often involved in mitochondrial d...
Source: Cardiophile MD - May 9, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Importance of cardiac imaging in patients with ventricular tachycardia
Late gadolinium enhancement on cardiac magnetic resonance imaging identifies scars likely to cause reentrant ventricular tachycardia. Ischemic scars are predominantly subendocardial while post inflammatory scars are predominantly sub epicardial. Scar in dilated cardiomyopathy is located in the mid wall region.
Imaging data is thus useful in deciding on the access (endocardial or epicardial approach) for ablation of ventricular tachycardia. Imaging will also tell us whether there is pericardial calcification which may interfere with catheter navigation in pericardial space in case of epicardial ablation. Similarly presence...
Source: Cardiophile MD - November 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiomyopathy in muscular dystrophies
Important muscular dystrophies due to mutations in structural cytoskeletal dystrophin gene are known as dystrophinopathies. They include Duchenne muscular dystrophy, Becker muscular dystrophy and X-linked dilated cardiomyopathy. Primary presentation of most dystrophinopathies is skeletal muscle weakness. Duchenne muscular dystrophy is caused by mutations leading to absence of functional dystrophin. Becker muscular dystrophy is due to mutations resulting in reduced amounts of shortened dystrophin protein.
Cardiac muscle being a striated muscle, is affected in many types of muscular dystrophies. Cardiomyopathy would contrib...
Source: Cardiophile MD - August 30, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Vaccine associated myocarditis revisited with COVID-19 mRNA vaccines
When I had reviewed the topic of vaccine associated myocarditis for an editorial in the BMH Medical Journal in 2017, most of the cases were associated with small pox vaccination [1]. There were also reports of streptococcal pneumonia vaccine and influenza vaccine associated myocarditis. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) used in the vaccine were also implicated in some cases [2,3].
While the large scale vaccination for small pox in an attempt to prepare for potential bioterrorism was the association in 2003 [4], COVID-19 mRNA vaccines are currently in the limelight for vaccine induced myocarditis...
Source: Cardiophile MD - July 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Cardiology MCQs
Which of the following is an innocent murmur?
Gibson’s murmur
Roger’s murmur
Still’s murmur
Dock’s murmur
Correct answer: 3. Still’s murmur
Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmur heard in the lower left sternal area. It is best heard with the bell of the stethoscope. Still’s murmur is a mid systolic murmur, loudest in supine position and diminishes in intensity on sitting and standing as venous return decreases [Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689]. Gibson’s murmur is the train-in-tunnel murmur or ma...
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Athlete ’ s heart
Athlete’s heart
Athlete’s heart denotes structural, functional and electrical remodeling seen in trained athletes. It is a physiological adaptation helping athletes perform physical tasks better than non-athletes [1]. Though most of the findings in athlete’s heart are related to the left ventricle, changes do occur in the right ventricle as well.
Effect of exercise on the left ventricle
During aerobic exercise which is isotonic, the heart rate and stroke volume increases. Systemic vascular resistance falls, but slight to moderate increase in blood pressure can occur due to the increased cardiac output. As...
Source: Cardiophile MD - June 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Left ventricular reverse remodeling
In this study, change in LVESV was the single most important predictor of all cause and cardiovascular mortality. Clinical parameters could not predict outcome events in this study.
Similar beneficial effect on left ventricular remodeling was demonstrated long back in the trials with angiotensin converting enzyme inhibitors. SOLVD (Studies of Left Ventricular Dysfunction) study showed that in patients with heart failure and reduced left ventricular ejection fraction, chronic treatment with angiotensin converting enzyme inhibitor enalapril prevented progressive left ventricular dilatation, systolic dysfunction and increase ...
Source: Cardiophile MD - June 11, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Metabolic modulation in heart failure
Most of the treatment strategies in heart failure like angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI) and beta blockers utilize hemodynamic modulation. Metabolic modulation on the other hand aims at dealing with myocardial energetic deficiency. Important agents in this group are trimetazidine, ranolazine and perhexiline [1]. Trimetazidine is a 3-ketoacyl coenzyme A thiolase inhibitor, while ranolazine inhibits the late sodium current. Perhexiline inhibits carnitine palmitoyl transferase.
A meta-analysis on trimetazidine published in ...
Source: Cardiophile MD - May 23, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
