In which of the three Eisenmenger syndromes is cardiomegaly unlikely?
In ventricular septal defect with Eisenmenger syndrome, cardiomegaly is unlikely. Though there will be cardiomegaly initially when there is a large left to right shunt, cardiac size regresses when left to right shunt decreases as pulmonary hypertension develops. Pulmonary arteries become prominent. Aorta is not prominent in VSD Eisenmenger. In patent ductus arteriosus with Eisenmenger syndrome, ascending aorta is prominent. Cardiac size comes down in PDA with large left to right shunt when pulmonary hypertension develops.
In atrial septal defect, cardiomegaly is mainly due to the enlarged right atrium. Pulmonary arteries ...
Source: Cardiophile MD - December 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What causes a prominent a wave in jugular venous pulse?
Prominent a wave occurs when the right atrial contraction is more forceful due to increased resistance to right atrial emptying. This occurs in right ventricular hypertrophy, pulmonary hypertension, and tricuspid stenosis. In pulmonary stenosis with right ventricular hypertrophy, prominent a wave would suggest intact interventricular septum. Prominent a wave will be absent in the presence of associated unrestrictive ventricular septal defect. This is because an unrestrictive VSD prevents right ventricular pressure from rising to suprasystemic levels. Prominent a wave can be associated with a presystolic hepatic pulsation....
Source: Cardiophile MD - November 5, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the mechanical complications of acute myocardial infarction?
Typical mechanical complications of acute myocardial infarction are rupture of papillary muscle, rupture of interventricular septum and rupture of left ventricular free wall. Mechanical complications are more life threatening and seldom respond to medical management. They need early high risk surgery. Rupture of papillary muscle causes severe acute mitral regurgitation and pulmonary edema. Rupture of interventricular septum produces an acquired ventricular septal defect and leads to severe heart failure. Rupture of ventricular free wall causes hemopericardium and cardiac tamponade. (Source: Cardiophile MD)
Source: Cardiophile MD - November 3, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are atrial switch operations? Cardiology Basics
Atrial switch operations were the initial operations developed for the treatment of transposition of great arteries. In transposition of great arteries, the aorta arises from the right ventricle and pulmonary artery from the left ventricle. Normally aorta originates from the left ventricle and pulmonary artery arises from the right ventricle.
Schematic diagram of transposition of great arteries
In transposition of great arteries, systemic venous return is pumped back into the body without being sent to the lungs for oxygenation. Blood returning from the lungs is pumped back into the lungs.
So, survival is impossible unles...
Source: Cardiophile MD - October 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Ebstein ’s anomaly? Cardiology Basics
What is Ebstein’s anomaly? Cardiology Basics
Ebstein’s anomaly is a congenital anomaly of the tricuspid valve, which may manifest soon after birth or more commonly later in life. In Ebstein’s anomaly, two of the three leaflets of tricuspid valve are displaced further into the right ventricle. Usually anterior leaflet is not displaced while the septal and posterior tricuspid leaflets are displaced. So, a part of the right ventricle becomes part of the right atrium functionally and is called atrialized right ventricle. Undisplaced anterior leaflet is elongated.
The tricuspid valve in Ebstein’s anomaly can have severe...
Source: Cardiophile MD - October 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Heart disease in pregnancy? Cardiology Basics
Changes in blood circulation during pregnancy and labour can adversely affect many of the significant heart diseases. Increase in blood volume and heart rate are the important factors during pregnancy. Increase in blood volume is needed to give enough nutrients and oxygen to the growing baby. Nutrients and oxygen are transferred to the baby through the placenta during pregnancy, though there is no actual mixing of the blood of the baby and mother. In general, obstructive lesions and complex cyanotic congenital heart diseases have high risk in pregnancy.
Obstructive lesions like severe aortic stenosis and mitral stenosis a...
Source: Cardiophile MD - October 21, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Eisenmenger syndrome? Cardiology Basics
Eisenmenger syndrome is a late complication of congenital heart diseases with large left to right shunts. Fortunately, it is rare now-a-days because most conditions which can cause Eisenmenger syndrome later, are detected by neonatal screening and treated early so that this complication does not develop later. Eisenmenger syndrome is a condition in which long standing high pulmonary blood flow leads to irreversible pulmonary hypertension with reversal of shunt. Right to left shunt causes reduced systemic oxygen saturation with cyanosis.
This is an echocardiogram showing a left to right shunt from the left ventricle to the...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the difference between pulsed wave and continuous wave doppler?
In pulsed wave Doppler, same piezoelectric crystal is used to transmit and receive the echo from the sample volume. Hence the signals are sent out in pulses and the intervals between the pulses are used to receive the echoes. In continuous wave Doppler, one piezoelectric crystal transmits continuously and another one receives continuously. As the transmission and reception are continuous, it is not possible to find out the depth from which the return signals are received. At the same time continuous wave Doppler can analyze higher velocities while pulsed wave Doppler can analyze only lower velocities.
In case of pulsed Do...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is TAPVC? Cardiology Basics
TAPVC stands for total anomalous pulmonary venous connection. It is also known as TAPVD or total anomalous pulmonary venous drainage. Normally, pulmonary veins join the left atrium. When it drains to the right atrium through one of the blood vessels leading to the right atrium, it is known as TAPVC. If only some of the four pulmonary veins join the right side of the heart, then it is called PAPVC or partial anomalous pulmonary venous connection.
When all the pulmonary veins join the right side of the heart instead of the left side, an atrial septal defect (ASD) is needed to maintain life. Otherwise body will not get any o...
Source: Cardiophile MD - October 19, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is colour Doppler echocardiography? Cardiology Basics
Usual colour Doppler echocardiogram is superimposition of colour Doppler images on a two dimensional echocardiogram. Colour M-Mode is superimposition of colour Doppler images on an M-Mode echocardiogram. The principle of Doppler is that the frequency of sound wave coming from an object which is moving towards the ultrasound probe increases while that from an object moving away from the probe decreases. It is similar to the difference in the sound of a train whistle, which is different when the train is moving towards you than when it is moving away from you. In Doppler echocardiography, the target is moving red blood cell...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a perimembranous VSD? Cardiology Basics
Perimembranous VSD is the commonest type of ventricular septal defect. When there is a ventricular septal defect, blood shunts from the left ventricle to the right ventricle as the pressure in the left ventricle is higher. This leads to increased pulmonary blood flow. VSD usually occurs as a congenital defect, though it can rarely occur in the adult after a myocardial infarction due to rupture of the ventricular septum. If the VSD is large, high pulmonary blood flow increases the amount of blood returning to the left atrium and left ventricle through the pulmonary veins. This volume overloading of the left ventricle can l...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How to interpret an echo report? Cardiology Basics
Echocardiogram, often called just echo in short is ultrasound imaging of the heart. Though the actual types of details mentioned in echo report may vary between institutions and even persons reporting it, in general there are several common aspects. Reports of children with congenital heart disease will have a different pattern. This discussion is mainly on an echo report from a general cardiology setup.
In addition to details of identification and date of procedure, indication for the study and the quality of images are usually mentioned in the beginning of the report. Quality of images may be poor in those with emphysem...
Source: Cardiophile MD - October 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Transesophageal echocardiogram (TEE)? Cardiology Basics
Echocardiogram is an image of the heart using ultrasound. An ultrasound beam is transmitted into the body using a device known as transducer. The echo received from the body is processed by the computer in the machine to give a moving image of the heart.
Transesophageal echocardiogram or TEE, is obtained by introducing a special type of transducer, also called a TEE probe, into the esophagus and stomach. Usual echocardiogram is obtained by placing the transducer or probe on the chest.
Lungs may overlap the heart intermittently while imaging the heart from the chest wall. This is because the lungs cover part of the heart d...
Source: Cardiophile MD - October 11, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Gerbode ventricular septal defects type I, II and III
Though congenital left ventricle to right atrium connections have been described as early as 1838 at autopsy [1, cited in 2], the description by Frank Gerbode and colleagues was in 1958, in their surgical series [3]. They described three varieties of communications:
Fusion of the septal leaflet of the tricuspid valve to the edges of the ventricular septal defect associated with a perforation of the leaflet. Shunt occurs from left ventricle directly into right atrium.
A defect or cleft of tricuspid valve close to its point of attachment directly overlying the VSD.
A combination of these two lesions.
They also described t...
Source: Cardiophile MD - September 8, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
New onset IRBBB
A PubMed search for new onset incomplete right bundle branch block returned 7 citations of which only two were on incomplete right bundle branch block. Another search on new onset IRBBB returned 40 citations but they were on RBBB rather than IRBBB.
The first result on IRBBB was in a study on hybrid transthoracic periventricular device closure of ventricular septal defects [1]. Three of their 59 patients developed incomplete right bundle branch block. One of them resolved during follow up. One had mild residual VSD shunt.
The second was on electrophysiological study before and after paramembranous ventricular septal ...
Source: Cardiophile MD - August 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
