Cardiology MCQ: a and v waves
False statement regarding ‘a’ and ‘v’ waves in atrial pressure tracing:
a) Right atrial ‘a’ wave is taller than ‘v’ wave
b) Left atrial ‘v’ is taller than ‘a’ wave
c) In atrial septal defect ‘a’ and ‘v’ waves are equal
d) None of the above
Correct answer: d) None of the above
Normally ‘a’ wave is taller in the right atrium and ‘v’ wave is taller in the left atrium [1]. In atrial septal defect, ‘a’ and ‘v’ waves are equal due to equalization of atrial pressures by the large unrestri...
Source: Cardiophile MD - March 13, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Source Type: blogs
Cardiac Surgeon Prints 3D Heart to Prep for Challenging Surgery
MRI of patient’s heart used to build the 3D printed model.
Though ventricular septal defects are fairly common and surgically treated, it’s best to plan the approach ahead of time. Since it’s usually done once the patient is opened and on bypass, there’s critical time wasted analyzing the anatomy and deciding on a plan. Richard Kim, a cardiac surgeon at Children’s Hospital Los Angeles (CHLA) , faced with a patient that had an unusual defect in the heart decided to print a 3D model of the actual heart produced from an MRI of the organ.
The replica allowed Dr. Kim to work out the best app...
Source: Medgadget - January 30, 2015 Category: Technology Consultants Authors: Editors Tags: in the news... Source Type: blogs
Low atrial rhythm – ECG
Low atrial rhythm
Brief Review
Abstract: Low atrial rhythm manifests with inverted P waves in inferior leads. It may be seen in sinus venosus atrial septal defect.
Low atrial rhythm
(Click on the image for an enlarged view)
This ECG shows inverted P waves in inferior leads (II, III and aVF). This indicates that the atrial activation is spreading from below upwards. It is suggestive of a focus either in the low atrium or high junction. A mid junctional rhythm will have no visible P waves as the P wave will be within the QRS due to simultaneous activation of the atria and ventricles. In low junctional rhythm the P wave occu...
Source: Cardiophile MD - January 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs
Rastelli procedure
Brief Review
Abstract: Rastelli procedure is done in cases of D-Transposition of great arteries with left ventricular outflow tract obstruction and ventricular septal defect, when arterial switch is not feasible.
Rastelli procedure is done in case of D-Transposition of great arteries (D-TGA) with ventricular septal defect and left ventricular outflow obstruction as arterial switch is not feasible. The ventricular septal defect is widened and the infundibular septum resected, followed by baffling of the left ventricle to the aorta.1
In the series of forty patients reported by Brown JW and associates2, the right ventricul...
Source: Cardiophile MD - January 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery d-TGA D-TGA with LV outflow obstruction Rastelli procedure Straddling tissue from tricuspid valve across the LV ouflow tract Source Type: blogs
Cor triatriatum
Brief Review
Abstract: Cor triatriatum or heart with three atrial chambers, could be either cor triatriatum sinistrum or cor triatriatum dexter depending on which side the additional chamber is present.
In cor triatriatum (cor triatriatum sinister1) there is a superior and inferior chamber with a membrane dividing the left atrium. In cor triatriatum dexter2, right atrium is divided into a medial and a lateral chamber. Though both are rare congenital anomalies of the heart, between the two, cor triatriatum dexter is less common.
Cor triatriatum sinister
Cor triatriatum sinister is often associated with other cardiac mal...
Source: Cardiophile MD - January 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology cor triatriatum Cor triatriatum dexter Cor triatriatum sinister Source Type: blogs
Hepato clavicular view for left ventriculography
Brief Review
Abstract: LAO (left anterior oblique) 40 degrees with 40 degrees cranial angulation is known as hepato clavicular view. It is used to profile inlet ventricular septal defects.
Hepato clavicular view with forty degree left anterior oblique and forty degree cranial angulation is used for visualizing the inlet ventricular septum. It is thus needed to see atrioventricular septal defects (endocardial cushion defects) and posterior muscular ventricular septal defects. This view has more cranial angulation and less lateral angulation than a conventional left anterior oblique (LAO) view. LAO view for aortography t...
Source: Cardiophile MD - January 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Source Type: blogs
Obligatory right to left shunt at the atrial level
Short Notes
Abstract: Obligatory right to left shunt at the atrial level occurs in tricuspid atresia, pulmonary atresia with intact interventricular septum and total anomalous pulmonary venous connection.
Obligatory right to left shunt at the atrial level means that the right to left shunt is mandated by the physiology in such a way that postnatal survival is not possible without that shunt.
Tricuspid atresia
The obligatory right to left shunt at atrial level is needed in tricuspid atresia because there is no other outlet for the right atrium. Blood returning to the right atrium from the vena cavae and coronary sinus rea...
Source: Cardiophile MD - January 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology obligatory right to left shunt at the atrial level TAPVC tricuspid atresia 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
Is stroke more common in PFO or ASD?
Short Notes
Abstract: Stroke is more likely because of the potential for R > L shunt in strain phase in PFO. In ASD the shunt is left to right and hence paradoxical embolism is less likely.
Paradoxical embolism can cause stroke in the presence of an interatrial communication. Emboli originating in the systemic veins usually travel to the pulmonary circulation causing pulmonary embolism. But in the presence of an interatrial communication, emboli originating from the systemic veins, usually from the deep veins of lower limb and pelvic veins, can traverse the interatrial septum and reach the left side of the heart...
Source: Cardiophile MD - January 5, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Indicators of large left to right shunt
Brief Review
Abstract: Indicators of a large left to right shunt are cardiac enlargement, presence of flow murmurs and third heart sound and a wide pulse pressure in case of patent ductus arteriosus.
Left to right intracardiac or extracardiac shunts typically increase the pulmonary blood flow. In a large left to right shunt, the Qp/Qs (ratio of pulmonary to systemic blood flow) is more than 2:1. Features of large shunts depends on the level of the shunt and also whether it is pre-tricuspid (before the tricuspid valve) or post tricuspid. The pre-tricuspid shunts are shunts at the level of great veins and at the atrial lev...
Source: Cardiophile MD - December 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Cardiac enlargement flow murmurs large left to right shunt third heart sound Wide pulse pressure Source Type: blogs
ECG Quiz
What is the rhythm?
a) Sinus rhythm
b) Low atrial rhythm
c) Idioventricular rhythm
d) None of the above
Answer: b) Low atrial rhythm
ECG showing negative P waves in inferior leads – II, III and aVF. A superior P wave axis means that the atrial activation is proceeding from below upwards. This occurs when the focus is in the low atrium (low atrial rhythm or coronary sinus rhythm). In addition the ECG also shows an intraventricular conduction defect (IVCD) in the form of notched R wave in lead II and aVF and an rSR’ pattern in lead III. Sometimes this pattern occurs in atrial septal defect and it is known as crochetage...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: DM / DNB Cardiology Entrance Source Type: blogs
Echocardiogram after TOF repair
Echocardiogram with video
Post TOF repair echo in PLAX view
Echocardiogram after repair of Tetralogy of Fallot (TOF) from the parasternal long axis (PLAX) view showing the hyperechoic region of the patch which was used to close the ventricular septal defect. The aortic over-ride is no more present. Ao: aorta; RV: right ventricle; LV: left ventricle; LA: left atrium.
Post TOF repair M-mode echo
M-mode echocardiogram after repair of TOF showing the abnormal septal motion which is biphasic and not in line with the movement of the posterior wall which shows regular contractions and relaxations.
Mild PR after TOF repair
The s...
Source: Cardiophile MD - December 19, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs
Normal colour Doppler echocardiogram – video
Normal colour Doppler echocardiogram
Echocardiogram video with detailed explanation
Echocardiogram in parasternal long axis view
Parasternal long axis view is usually the first view obtained during echocardiography. It is obtained by keeping the transducer in the left parasternal region, with the subject in the left lateral position. The beam cuts the heart in its base to apex axis (long axis). Aortic root (Ao) and valves, left ventricle (LV), left atrium (LA), mitral valve, chordae tendinae, papillary muscles, interventricular septum (IVS) and part of the right ventricle are imaged in this view. Cross section of the de...
Source: Cardiophile MD - December 19, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs
Ellis-van Creveld syndrome
Ellis-van Creveld syndrome is an autosomal recessive disorder with single atrium as the hallmark cardiovascular defect. Single atrium is sixty percent of the cases. Other cardiac defects like those of mitral and tricuspid valve, patent ductus arteriosus, ventricular septal defect and even hypoplastic left heart syndrome have been described.
The affected individuals have short limbs and hence short stature, short ribs, polydactyly and dysplasia of teeth and nails. The syndrome was described by Richard WB Ellis and Simon van Creveld [Ellis RWB and van Creveld S. A syndrome characterized by ectodermal dysplasia, polydactyly,...
Source: Cardiophile MD - November 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Cardiology MCQ: Ellis-van Creveld syndrome
Most common cardiac anomaly in Ellis-van Creveld syndrome:
a) Ventricular septal defect
b) Patent ductus arteriosus
c) Single atrium
d) Single ventricle
Correct Answer:c) Single atrium
Single atrium is seen in 40 – 60% cases of Ellis-van Creveld syndrome. Other cardiac defects like those of mitral and tricuspid valve, patent ductus arteriosus, ventricular septal defect and even hypoplastic left heart syndrome have been described. Mutations in two genes – EVC and EVC2 situated on the same chromosome have been documented in Ellis-van Creveld syndrome. It is an autosomal recessive disorder. Other features are sho...
Source: Cardiophile MD - November 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
