Jugular venous pulse (JVP)
Assessment of jugular venous pulse has to be done in the internal jugular vein though a beginner is often tempted to use the external jugular vein. External jugular vein may be kinked and it may not reflect the true right atrial pressure. Jugular venous pressure is measured with reference to the sternal angle. The sternal angle is 5 cm above the mid right atrium in all positions. Normal internal jugular venous pulsations are not visible in the neck in the sitting position. Hence it is typically measured with 45 degrees propped up position. But if the venous pressure is elevated, measurement in sitting position is possible...
Source: Cardiophile MD - September 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC abdominojugular reflux cannon waves Friedreich’s sign hepatojugular reflux Superior vena cava syndrome Source Type: blogs
General examination – eyes and facial dysmorphism
General examination – eyes and facial dysmorphism
Clinically examination is guided by the symptoms. Unless the history is not correlated with findings, important diagnostic possibilities may be missed. Clinical examination starts off with a focused general examination followed by a detailed examination of the cardiovascular system. Relevant points in other systems like basal crepitations, hepatosplenomegaly and neurological deficits should be looked for.
Examination strategy should be fitting to the clinical situation. When a patient presents to the emergency room, it should be a short but focused examination to perm...
Source: Cardiophile MD - September 21, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
One more cause for acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some cente...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs
Please add, one more cause for Acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some cente...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs
Oxygen step up in right atrium – MCQ – Answer
Oxygen step up in right atrium – MCQ – Answer
Step up in oxygen saturation on cardiac catheterization in the right atrium is suggestive of – Correct answer: a) Atrial septal defect
In ventricular septal defect oxygen step up is seen at ventricular level. For example, if the oxygen saturation is 64% in the right atrium, it becomes 82% in the right ventricle due to entry of oxygenated blood from the left ventricle across the ventricular septal defect. In patent ductus arteriosus, oxygen step up is noted at the level of the pulmonary artery.
Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
Oxygen step up in right atrium – MCQ
Oxygen step up in right atrium – MCQ
Step up in oxygen saturation on cardiac catheterization in the right atrium is suggestive of:
a) Atrial septal defect
b) Ventricular septal defect
c) Patent ductus arteriosus
d) All of the above
Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - March 31, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
Pulmonary artery systolic pressure – MCQ – Answer
Pulmonary artery systolic pressure – MCQ – Answer
Normal pulmonary artery systolic pressure – Correct Answer: b) 15 – 30 mm Hg
Pulmonary circulation is a low pressure circulation and the pressures are much lower than that of systemic circulation. An acute rise in systolic pressure to 50 mmHg can cause right heart failure in conditions like pulmonary embolism. But gradually rising pressures are better tolerated as the right ventricle has time to compensate by hypertrophy. In severe primary pulmonary hypertension and atrial septal defect with severe pulmonary hypertension, pulmonary pressures can even be sup...
Source: Cardiophile MD - March 17, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
Dyskinetic apical pulsation – MCQ
Dyskinetic apical pulsation – MCQ
Dyskinetic apical pulsation can be seen in:
a) Mitral regurgitation
b) Ventricular septal defect
c) Atrial septal defect
d) Left ventricular aneurysm
Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - February 25, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
A young woman with epigastric pain. ECG Crochetage sign? What is the significance?
A former resident texted me this ECG, done for epigastric pain in an 18 year old. The pain resolved immediately with treatment for acid reflux, and in the clinician ' s opinion was clearly GI in origin, but he wanted to know what the strange waves in the QRS were:See the unusual notching in II, III, aVF, and V2-V4.I had no idea what they were. They reminded me of theDelayed Activation Wave associated with circumflex acute MI.See this case: https://hqmeded-ecg.blogspot.com/2018/05/is-there-delayed-activation-wave.html.But they are clearly different from this.I put it on Facebook EKG club and this is th...
Source: Dr. Smith's ECG Blog - January 7, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Congenital heart disease and autism: A possible link?
Children born with congenital heart disease (CHD) are now surviving at extraordinarily high rates; for most, their life expectancy may be comparable to that of the general population. However, despite the great advances in medical and surgical care, many people with CHD experience long-lasting neurodevelopmental difficulties. These include problems with attention and executive function skills, learning challenges, and in some cases, lower-than-normal IQs.
Study links congenital heart disease and autism
A recent study published in the journal Pediatrics provides compelling evidence that there may also be an association betw...
Source: Harvard Health Blog - January 2, 2020 Category: Consumer Health News Authors: Johanna Calderon, PhD Tags: Children's Health Heart Health Parenting Screening Source Type: blogs
Pulmonary valvotomy for Tetrology of Fallot : Will soon become a worthy option
Catheter based interventions in TOF has caught the imagination of Interventional cardiologists.decades ago. (Quereshi reported first in 1988 Royal Liverpool hospital ) .Somehow it could not develop into a full-fledged modality. The key issue in TOF is, RVOT obstruction is infundibular with some degree of valvular involvement. While the valvular component is amenable for easy correction by balloon, the infundibular stenosis requires some form of cutting or splitting. Embryologically, the malalignment of IVS is the primary mechanism of obstruction. The balloon catheter is will find it difficult to tackle the alignm...
Source: Dr.S.Venkatesan MD - December 24, 2019 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -congenital heart disease cardiology -Therapeutics Interventions -Structural heart disease Tetrology of Fallot balloon pulmonary valvotomy in tof camera tipped catheters cyanotic spell in tof tetrology management emergency balloon Source Type: blogs
Persistent Ventricular Fibrillation, ED ECMO, ED TEE, ROSC, Shark Fin ECG (also called " Giant R-wave " ), Postinfarction Regional Pericarditis. What a Case!
A 40-something suffered witnessed ventricular fibrillation, had bystander CPR, but could not be defibrillated after 4 attempts.He was transferred to the ED and put on extracorporeal life support (ECLS, ECMO).A series of ED Transesophageal echos (TEE) was done over 23 minutes before an ECG was recorded. We usually do not get ROSC before angiography in these cases, and recording the ECG is not as important as usual, because we send them all to the cath lab by our ECMO protocol.This is before another defibrillation attempt, during chest compressions:Orientation:The probe is in the esophagus, right next to the left ...
Source: Dr. Smith's ECG Blog - November 21, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Name that murmur
Dr Andrew Robbins Name that murmur
Eponymythology of named cardiac murmurs. Related eponyms, the person behind their origin, their relevance today, and modern terminology. (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - November 4, 2019 Category: Emergency Medicine Authors: Dr Andrew Robbins Tags: Cardiology Eponymythology Bruit de Roger George Frederic Still Henri-Louis Roger Maladie de Roger Roger’s murmur Still's murmur ventricular septal defect Source Type: blogs
Gore CARDIOFORM ASD Cleared in Europe for Atrial Septal Defects
Gore won the European CE Mark for its GORE CARDIOFORM ASD Occluder, a device designed for percutaneous, transcatheter closure of ostium secundum atrial defects (ASDs). The occluder recently completed a clinical study involving 125 patients with ASD, ranging from 2 to 84 years of age, all of whom were successfully implanted with the GORE CARDIOFORM ASD and maintained closure six months later.
The device is made of two discs that make contact with the tissue walls on both sides of the opening and, when engaged, come together to block the passage of blood between the atria. It was recently approved by the FDA for ASD, as ...
Source: Medgadget - October 8, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
We Can Stop America ’ s Surge in Opioid-Dependent Babies
By STUART H. SMITH
Imagine a massive public health crisis in the United States that affects tens of thousands of people. Now imagine that the government had a simple tool at its disposal that could prevent this kind of physical and psychological trauma. You might think that I’m writing about America’s deadly outbreak of gun violence, which has made headlines this summer from Dayton to El Paso.
But actually I’m talking about a different crisis that affects even more people – all of them children — and which could be sharply reduced with one simple step that lacks the bitter political animus of the gun debate...
Source: The Health Care Blog - September 18, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Patients Big pharma NAS syndrome Opioid Justice Team Opioid-Dependent Babies Opioids public health Stuart Smith Source Type: blogs
