M-Mode echocardiography
(Time-motion mode) was one of the earliest tools of the echocardiographer. M-Mode gives an ice-pick view of the heart. The vertical axis gives the distance of each point from the transducer while horizontal axis gives the time period. M-Mode gives high resolution in the time axis so that it is easy to time various events in the cardiac cycle, especially if a synchronized ECG tracing is displayed along with it. One of the commonest sites of imaging is the parasternal region. As we sweep from base to apex, the initial section imaged will have the aorta anteriorly and left atrium posteriorly. The next set of images is taken ...
Source: Cardiophile MD - December 5, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Echocardiography anatomical M-Mode Source Type: blogs
Pulmonary edema after device closure of ASD
Brief Review
Device closure of atrial septal defect (ASD) is almost replacing surgical ASD closure in all cases with suitable morphology. Percutaneous ASD closure is usually well tolerated. One of the rarest complications in literature following device closure of atrial septal defect is the occurrence of pulmonary edema after ASD device closure. Acute pulmonary edema is well reported after surgical closure of ASD, especially in the elderly, when a sudden increase in the preload to a poorly compliant and small left ventricle leads to diastolic heart failure.
One of the earliest reports of left heart failure after device cl...
Source: Cardiophile MD - December 4, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions left ventricular conditioning for ASD device closure pulmonary edema after ASD closure pulmonary edema after closure of atrial septal defect Source Type: blogs
Truncus arteriosus
is a cyanotic congenital heart disease in which one single great vessel with a single semilunar valve gives rise to the aorta, pulmonary arteries and the coronary arteries. There are three morphological types depending on the origin of pulmonary arteries from the truncus. In type I, a common pulmonary trunk arises from the truncus arteriosus and divides into left and right pulmonary arteries. In type II, the two pulmonary arteries arises separately, but adjacent to each other, from the truncus. In type III, the two pulmonary arteries arise separately from either side of the truncus. The older classification had a type IV ...
Source: Cardiophile MD - December 3, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology General Cardiology Source Type: blogs
Cyanotic spell
Brief Review
Cyanotic spells are episodes of worsening of cyanosis (also called hypercyanotic spells, Tet spell for short [1]) in infants with cyanotic congenital heart disease with low pulmonary blood flow (Tetralogy of Fallot physiology). Tet spells can also rarely occur in adults with Tetralogy of Fallot [1]. Cyanotic spells are associated with hyperpnea and may lead to loss of consciousness and even hypoxic seizures if the episodes are prolonged. They can be precipitated by crying or other forms of exertion.
A rare instance of refractory cyanotic spell in a patient with Tetralogy of Fallot due to thrombus in right ve...
Source: Cardiophile MD - November 26, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Cyanotic spells in D-TGA with LVOT obstruction Tet spell Tetralogy of Fallot Source Type: blogs
Cone procedure for Ebstein’s anomaly
Brief Review
Cone procedure for Ebstein’s anomaly of tricuspid valve constructs a funnel like valve using the native valve leaflets. This avoids the problems associated with artificial valves including bioprosthetic valves, especially in children. In one study cone procedure group had 85% reduction in tricuspid regurgitation compared to 56% in the conventional group, at discharge from hospital [1]. The cone procedure involves detachment of tricuspid leaflets, division of chordae, plication of the tricuspid annulus, rotation of leaflets and final re-insertion of the leaflets in the modified tricuspid valve annulus [2...
Source: Cardiophile MD - November 22, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cone procedure Ebstein's anomaly Source Type: blogs
Patients in the Himalayas Grateful for Care
BY RACHEL EDWARDS, MD
I traveled to India in August 2014 with Himalayan Health Exchange (HHE), which organizes groups of attending physicians, residents, medical students, and nurses from around the world to travel to one of the most remote parts of the world, deep in the Himalayan Mountains. Our route took us to the Pangi Valley of Northern India, where the road we traveled has only existed for a decade and is impassable during the winter months when the road is covered in snow. The people who live there are resilient and hardened by their environment of mountainous terrain and harsh climate.
Our group, escorted...
Source: Going Global - November 18, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Patients in the Himalayas Grateful for Care
BY RACHEL EDWARDS, MD
I traveled to India in August 2014 with Himalayan Health Exchange (HHE), which organizes groups of attending physicians, residents, medical students, and nurses from around the world to travel to one of the most remote parts of the world, deep in the Himalayan Mountains. Our route took us to the Pangi Valley of Northern India, where the road we traveled has only existed for a decade and is impassable during the winter months when the road is covered in snow. The people who live there are resilient and hardened by their environment of mountainous terrain and harsh climate.
Our group, es...
Source: Going Global - November 18, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Swiss cheese VSD (ventricular septal defect)
Multiple muscular ventricular septal defects (VSD) are also called swiss cheese VSD. Swiss cheese VSDs are associated with left axis deviation on ECG. Swiss cheese VSDs are difficult to close surgically. It is difficult to locate the openings of the VSD from the right ventricular side. Some may have multiple right ventricular openings for a single left ventricular orifice. When one right ventricular orifice is closed, the VSD may be seen puffing from another orifice. These VSDs may require left ventriculotomy for closure, which is a problem in a small infant. Recently special techniques using a thread passed from the right...
Source: Cardiophile MD - November 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery adjustable PA banding adjustable pulmonary artery banding excessive pulmonary blood flow left axis deviation on ECG Multiple muscular ventricular septal defects PAH Swiss cheese ventricular septal defects Swiss cheese VSD Source Type: blogs
Atrial septal defect (ASD)
Illustrated Review with ECG, CXR, Echo Video, Cath Images
X-ray chest in atrial septal defect
X-ray chest PA view in atrial septal defect with pulmonary hypertension
(Click on the image for an enlarged view)
The main pulmonary artery (MPA) is grossly dilated. The right pulmonary artery (RPA) is also quite enlarged. Right atrial enlargement is seen as a shift of the cardiac contour to the right of the spine. Pulmonary vascularity is increased and prominent end on vessels (End on) are also seen. Apex is upwards, suggesting a right ventricular configuration. All features suggest a large secundum atrial septal defect with a l...
Source: Cardiophile MD - November 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology X-ray ECG / Electrophysiology Echocardiography Structural Heart Disease Interventions ASD Crochetage Sign ASD ECG ASD echo ASD Echo Video ASD X-Ray Chest PA Colour Doppler Echo in ASD ECG in A Source Type: blogs
Ventricular interdependence
Brief Review
Ventricular interdependence is the term used to describe the dysfunction of one ventricle secondary to a disorder of the other, mainly due to the involvement of the interventricular septum which is common to both ventricles. During spontaneous inspiration, right ventricular volume increases, pushing the interventricular septum towards the left ventricle. This leads to an increase in left ventricular filling pressure with an unchanged or lower left ventricular end diastolic volume. This is a diastolic interventricular interaction which is always present [1].
Studies have shown that twenty to forty percent of ri...
Source: Cardiophile MD - November 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Cardiac tamponade diastolic interventricular interaction Dornhorst's theory Source Type: blogs
Patent foramen ovale – PFO
Patent foramen ovale (PFO) is a valvular opening in the fossa ovalis region of the interatrial septum. In fetal life, the foramen ovale shunts relatively more saturated inferior vena caval blood coming from the umbilical vein to the left atrium from the right atrium. This blood with higher oxygen level reaches the left ventricle and gets pumped to the upper part of the body including the brain. Superior vena caval blood streams to the right ventricle from the right atrium and reaches the pulmonary artery. Since the lungs are non functional, the blood from the pulmonary artery is shunted to the descending thoracic aorta thr...
Source: Cardiophile MD - November 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiography PFO Source Type: blogs
Intramural VSD
Intramural Ventricular Septal Defect (VSD)
Intramural VSD is a type of residual VSD seen after repair of complex defects like double outlet right ventricle, truncus arteriosus or Rastelli procedure for transposition of great arteries. The intramural VSD originates between the insertion of the VSD closure patch and the aortic valve. The defect occurs because of coarse trabeculae of the hypertrophic right ventricle prevent good seal at the site of patch insertion so that blood can tunnel through the trabeculae from the left ventricular outflow tract into the right ventricle through its wall (intramural). Due to the peculiar ...
Source: Cardiophile MD - October 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs
Test your medicine knowledge: 33-year-old woman with atrial fibrillation
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 33-year-old woman is evaluated as an outpatient following an episode of atrial fibrillation. The episode resolved shortly after she arrived at the emergency department. She has a history of tetralogy of Fallot with repair performed at the age of 4 years.
On physical examination, blood pressure is 110/70 mm Hg, pulse rate is 62/min and regular, and respiration rate is 18/min. BMI is 28. The estimated central venous pressure is normal. The apical impulse is normal; there is a parasternal impulse at the left ster...
Source: Kevin, M.D. - Medical Weblog - September 19, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
A rare case in a rural doctor’s office
I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath.
He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he had a morning cough and got a little winded running up and down the basement stairs or shoveling snow in the winter.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. F...
Source: Kevin, M.D. - Medical Weblog - May 2, 2015 Category: Journals (General) Authors: A Country Doctor, MD Tags: Conditions Primary care Pulmonology Source Type: blogs
Atrial Septal Defect (ASD)
Atrial septal defect (ASD) is one of the commonest congenital heart diseases in the adult. It is a defect in the septum separting the two upper chambers of the heart. The defect in the septum between right and left atrium can be in various locations. The commonest variety which occurs almost in the centre is known as ostium secundum type. If it occurs at the lower end, it is called ostium primum variety. Ostium primum defect is often associated with a cleft of the mitral valve and leakage of the mitral valve (mitral regurgitation). There is another type of defect known as sinus venosus ASD. Sinus venosus ASD can occur ne...
Source: Cardiophile MD - April 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
