Atrial septal defect
This video covers certain features of atrial septal defect including X-ray chest, ECG, echocardiogram and finally device closure of ASD. Both secundum and primum ASDs are demonstrated. Transesophageal echo images of ASD are also shown. Fluoroscopic view of ASD device with delivery cable and venous sheath is seen at the end.
Another video without narration, showing TEE in dual ASD is shown below: (Source: Cardiophile MD)
Source: Cardiophile MD - November 20, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography ASD ASD device closure dual ASD ostium primum ASD ostium secundum ASD TEE in ASD Source Type: blogs
Echocardiograms in a few congenital heart diseases
In this series, we have echocardiograms of a few congenital heart diseases. The first one shows left ventricle to right atrium shunt associated with a perimembranous ventricular septal defect. Various possibilities are discussed. The second one shows an ostium primum atrial septal defect with tricuspid regurgitation. Associated tricuspid regurgitation is also seen. Third one shows a few views of tetralogy of Fallot (TOF). There is a patent ductus arteriosus associated with TOF in this case. The intact patch at the site of intracardiac repair of the subaortic ventricular septal defect in TOF is seen in the last few frames...
Source: Cardiophile MD - November 8, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography ASD LV-RA shunt ostium primum ASD perimembranous VSD TOF Source Type: blogs
Tetralogy of Fallot – Pre and Post Repair Echocardiogram
Tetralogy of Fallot – Pre and Post Repair Echocardiogram
Tetralogy of Fallot is the commonest cyanotic congenital heart disease in the adult. Large subaortic ventricular septal defect with overriding aorta, infundibular pulmonary stenosis and right ventricular hypertrophy are the components of tetralogy of Fallot. A patent ductus arteriosus is seen in this case as a natural protective mechanism to improve the pulmonary blood flow.
The echocardiogram after repair shows the intact patch over the erstwhile subaortic ventricular septal defect. There is no residual ventricular septal defect. (Source: Cardiophile MD)
Source: Cardiophile MD - November 6, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography aortic override continuous flow across the ductus patch across the ventricular septal defect patent ductus arteriosus right to left shunt Tetralogy of Fallot Source Type: blogs
ECG and CXR in ASD
ECG in atrial septal defect
Atrial fibrillation may be seen in adults. Atrial flutter can occur in ASD, even after repair. Inverted P waves seen in inferior leads indicate low atrial rhythm (also known as coronary sinus rhythm) in sinus venosus atrial septal defect. This is due to defective sinus node as the septal defect is in the region of the sinoatrial node. Classical QRS pattern in ASD is the rSR’ in V1 suggestive incomplete right bundle branch block. This pattern in ASD is due to right ventricular volume overload. QRS axis is usually rightward, more so when there is severe pulmonary hypertension. Left axis dev...
Source: Cardiophile MD - October 11, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Coronary sinus rhythm crochetage sign in ASD end on vessels in ASD hilar dance in ASD Low atrial rhythm pulmonary plethora Source Type: blogs
Ostium primum ASD and clinical findings of ASD
Ostium primum ASD
Ostium primum atrial septal defect is part of the AV canal defects. In partial AV canal defect, ostium primum ASD is often associated with cleft anterior mitral leaflet producing mitral regurgitation. Tricuspid regurgitation may also be noted. In complete AV canal defect, there is associated canal VSD or inlet VSD and sometimes a single AV valve.
Ostium primum ASD being part of the endocardial cushion defects, may be associated with Down syndrome. They are more likely to develop pulmonary hypertension and Eisenmenger syndrome earlier. DiGeorge syndrome and Ellis-Van Creveld syndrome are the other conditi...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Wide fixed split of second heart sound Source Type: blogs
ASD overview and secundum ASD
Atrial septal defect (ASD) is the commonest congenital heart disease in the adult, barring of course bicuspid aortic valve. ASD being a post tricuspid shunt, development of pulmonary hypertension and Eisenmenger syndrome is delayed and survival to adult age group is common. Some even argue that pulmonary hypertension in ASD is primary pulmonary hypertension which the individual was otherwise destined to develop. Anyway pulmonary hypertension is likely to develop in ASD with large left to right shunt of long duration, though the severity of pulmonary hypertension is variable. Supra systemic pulmonary arterial pressures are...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Bimodal pattern of cyanosis in ASD ostium primum ASD ostium secundum ASD Secundum atrial septal defect sinus venosus ASD Spontaneous closure of ASD Source Type: blogs
ECG and CXR in ventricular septal defect
ECG in ventricular septal defect
ECG is normal in a small ventricular septal defect. Large VSD with large left to right shunt will have left ventricular volume overload with small q, tall R and upright T waves in lateral leads. Large VSD progresses to biventricular overload when there is hyperdynamic pulmonary hypertension. The ECG pattern of biventricular hypertrophy is called Katz – Wachtel phenomenon with tall biphasic (R=S) QRS complexes with amplitude over 50 mm in mid precordial leads. This pattern is usually seen in children. Since the QRS amplitude is high it often overshoots the margin of the ECG graph as seen ...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Katz – Wachtel phenomenon peripheral pruning Source Type: blogs
Ventricular septal defect
Ventricular septal defects (VSD) can be divided into perimembranous, muscular, inlet and outlet VSDs, depending on the location. Of these perimembranous VSDs are the commonest. VSDs can decrease in size and undergo spontaneous closure. Spontaneous closure is most likely with small muscular and perimembranous VSD, while inlet and outlet VSDs are least likely to close.
Perimembranous ventricular septal defect
Perimembranous VSD with perimembranous aneurysm
Echocardiogram in ventricular septal defect: Parasternal long axis view shows the subaortic perimembranous ventricular septal aneurysm (marked by arrows). The color mosai...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC atrioventricular septal defect doubly committed VSD Eisenmenger complex Eisenmenger reaction Gerbode VSD Inlet ventricular septal defect maladie de Roger Muscular ventricular septal defect Outlet ventricular septal defect perimembr Source Type: blogs
Congenital heart disease overview
Congenital heart disease can be broadly classified into cyanotic and acyanotic. Acyanotic congenital heart disease can be further subdivided into left to right shunts, obstructive lesions and a miscellaneous group. Cyanotic congenital heart disease can be classified into those with decreased pulmonary blood flow and those with reduced pulmonary blood flow.
Left to right shunts include atrial septal defect, ventricular septal defect, patent ductus arteriosus and aortopulmonary window. One person can have more than one of these shunts. Large left right shunts can induce the development of pulmonary hypertension and lead to ...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Chamber enlargements on ECG
Atrial enlargement
The normal P wave has a maximum amplitude of 2.5 mm (0.25 mV) and a maximum width of 2.5 mm (100 ms). In right atrial enlargement, the amplitude increases while in left atrial enlargement, it is the width (duration) which increases. Both increases in biatrial enlargement. P wave abnormalities are best assessed in leads II and V1. Normal P wave is upright in lead II. In V1, a tiny initial spike is followed by a shallow negative wave.
P mitrale: P mitrale is a notched and broad P wave with taller second peak indicating left atrial enlargement. It may be noted that initial part of P wave is contributed b...
Source: Cardiophile MD - September 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC incomplete right bundle branch block pattern Left ventricular pressure overload left ventricular volume overload LVH strain pattern P mitrale P pulmonale P tricuspidale Right ventricular pressure overload right ventricular volume ove Source Type: blogs
Cardiac murmurs
Cardiac murmurs are initially classified into systolic, diastolic and continuous. They can be timed in relation to the carotid pulse. A systolic murmur starts with or after the first heart sound and ends at or before the second heart sound. Clinically, systole can be timed with the onset of carotid pulse. Diastolic murmurs start with or after the second heart sound. By definition, a continuous murmur starts in systole, persists through the second heart sound, into the diastole. When the pressure gradient is high between the two chambers across which the murmur is generated is high, the murmur is high pitched.
Levine’s g...
Source: Cardiophile MD - September 24, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Austin Flint murmur continuous murmur crescendo-decrescendo murmur delayed diastolic murmur diamond shaped murmur Early diastolic murmur Ejection systolic murmur Gibson’s area Gibson’s murmur Graham steel murmur holosystolic Source Type: blogs
Heart sounds
Two normally heard heart sounds are the first heart sound (S1) and second heart sound (S2). Second heart sound has two components – aortic (A2) and pulmonary (P2). Normal A2 is heard in all auscultatory areas while normal P2 is heard only in the pulmonary area. If it is heard at the apex, it can be considered as loud P2. Normal split of second heart sound closes in expiration and is audible only in inspiration. If it is audible in both inspiration and expiration, it is called wide split. If the split increases in expiration and closes in inspiration, it is paradoxical split. Wide fixed split is audible in both inspirati...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Paradoxical splitting of second heart sound sail sound Wide fixed split wide split Source Type: blogs
Auscultatory areas
Precordium is generally divided into four auscultatory areas, but other areas may be checked in specific situations. The common auscultatory areas correspond to the locations at which the corresponding valvular events are better heard.
Aortic area: Also called primary aortic area as there is a secondary aortic area along the left sternal edge. Primary aortic area is the 2nd right intercostal space, close to sternum.
Pulmonary area: 2nd left intercostal space, close to sternum.
Tricuspid area: Lower left sternal edge, medial to apex beat.
Mitral area: At the apex beat, usually within the mid clavicular line in the 5th lef...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Erbs’s area maladie de Roger primary aortic area Roger’s area secondary aortic area Source Type: blogs
Palpation of precordium and adjacent areas
Palpation initially confirms the findings of inspection and further looks for new findings.
Apex beat: Apex beat is defined as the lowest and outer most point of definite cardiac impulse. If apex beat is not felt on left side, immediately check on right side or else we might miss a dextrocardia. There some who even palpate both sides simultaneously for this reason. Apex beat is initially felt with the palm of the hand and then localized with the index finger. Sometimes it may be difficult to palpate in obese individuals and in those with emphysema. Palpation in held expiration and in the left lateral position may help in...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Inspection of precordium
Precordial examination starts with inspection, though inspection and palpation are often combined in regular practice. Some of the features to look for are:
Sternal deformities: Pectus excavatum is concavity of the sternum, and is the commonest congenital malformation of the chest wall which may be associated with congenital heart diseases like ventricular septal defect. Pectus carinatum is sternal prominence, also known as pigeon chest, which can occur in congenital heart disease with large left to right shunts in infancy.
Visible pulsations: Suprasternal pulsations can be seen in aortic aneurysm and aortic regurgitatio...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
