Cardiology MCQ Test 5
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Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 3
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Source: Cardiophile MD - October 20, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Echocardiogram in ventricular septal defect (VSD)
Echocardiogram in parasternal long axis view shows the subaortic perimembraneous ventricular septal aneurysm (marked by arrows). There is a small ventricular septal defect at the apex of the aneurysm which is not very clear in the 2D (two dimensional) image. Right panel shows the mosaic (red multicoloured) VSD jet from the apex of the aneurysm into the right ventricle. Other structures seen in the image (not marked are the aorta (with blue colour flow mapping in right panel), left ventricle (to the left and below the VSD jet) and the left atrium (below and to the left of aortic blue jet). Mitral valve in the closed positio...
Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 2
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Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Young people, stroke and a hole in the heart (PFO)
(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)
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We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may be the worst outcome in all of medicine. That’s because stroke can permanently remove basic functions of being human, things such as speech, thought, personality, movement, swallowing, and many others.
Stroke is not supposed to happen in young people. But sometimes it does. And in some of t...
Source: Dr John M - September 28, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
ASD on colour Doppler echocardiogram
Subcostal view showing a 15 mm secundum atrial septal defect
RA: Right atrium; LA: Left atrium; ASD: Atrial septal defect; SVC flow: Flow from superior vena cava into the right atrium. ASD flow: Left to right shunt from left atrium to right atrium (Red colour of the flow is because flow is towards the transducer; right to left shunt will be blue in colour in the subcostal view as the flow would be away from the transducer). Slight mosaic colour of the ASD flow jet is seen, indicating mild turbulence of the stream. In this view the ASD is seen to have good rims on either side, suggesting that it may be an ideal case for...
Source: Cardiophile MD - August 31, 2017 Category: Cardiology Authors: Johnson Francis Tags: Echocardiogram Library Echocardiography ASD ASD flow Atrial septal defect left atrium left to right shunt right atrium secundum ASD subcostal view SVC flow Source Type: blogs
MD vs. DNP: Why 20,000 Hours of Training and Experience Matters
By NIRAN AL-AGBA, MD
As southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation. While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base. They should not identify themselves as “doctors” despite having a Doctor of Nursing Practice (DNP) degree. It is misleading to patients, as most do not realize the difference in education necessary for an MD or DO compared to a DNP. Furthermore, until they are required to...
Source: The Health Care Blog - May 29, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Multiple echo views in EMF
Parasternal long axis (PLAX) view being the first view taken in most echocardiographic studies, gives this image with dilated right ventricular outflow tract (RVOT). This pattern alone will not give a suspicion of endomyocardial fibrosis (EMF) as RVOT can be dilated along the with the rest of the right ventricle in conditions causing right ventricular volume overload like an atrial septal defect as well as in Ebstein’s anomaly of the tricuspid valve. Conditions with a dilated RVOT will have a characteristic clinical finding of RVOT pulsations, along the left sternal border, in the third intercostal space. Pulsation i...
Source: Cardiophile MD - December 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Interatrial septum in subcostal view
In an earlier post it was shown that false echo dropouts can occur in the interatrial septum as the ultrasound beam is parallel to the structure being imaged. It was also mentioned that subcostal view is best for imaging the interatrial septum. This picture in subcostal view gives an excellent image of the interatrial septum (IAS) between the right atrium (RA) above and the left atrium (LA) below. LV: Left ventricle. Most echocardiographers use this orientation for subcostal view, though it is anatomically an inverted view as the transducer is kept below the structures being imaged. On the contrary, most paediatric echoca...
Source: Cardiophile MD - December 15, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Parasternal long axis view in normal echocardiogram
RV FW: Right ventricular free wall; RV: Right ventricle; IVS: Interventricular septum; Ao: Aorta; RCC: Right coronary cusp of aortic valve; NCC: Non coronary cusp of aortic valve; LVOT: Left ventricular outflow tract; AML: Anterior mitral leaflet; PML: Posterior mitral leaflet; LA: Left atrium; LV: Left ventricle; LV PW: Left ventricular free wall.
Parasternal long axis view is often the first view taken during two dimensional echocardiography. It is taken from the left parasternal region with the ultrasound beam in plan parallel to the base-apex (long axis) of the heart. If the transducer is turned ninety degrees from thi...
Source: Cardiophile MD - December 13, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Echo drop out in interatrial septum
An echo drop out in the interatrial septum is often noted in the apical four chamber view. This need not mean that there is an atrial septal defect. This is because the thin atrial septum in the region of the foramen ovale is often not imaged well in the apical four chamber view as the ultrasound beam is parallel to the inter atrial septum. For a good ultrasound image, the structure being imaged should be perpendicular to the ultrasound beam. In case of Doppler the beam should be parallel to the flow being imaged. LV: left ventricle; RV: right ventricle; LA: left atrium; RA: right atrium; PV: pulmonary vein; IAS: inter atr...
Source: Cardiophile MD - December 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Small muscular ventricular septal defect – echocardiogram
Echocardiogram in apical 5 chamber view shows the mosaic colour jet of a small ventricular septal defect (VSD) near the apex. The cardiac chambers are not dilated. The small defect is difficult to see on two dimensional echocardiography, though it is easily detected clinically with a pan systolic murmur and Doppler echo documents the high velocity jet across the VSD. LV: Left ventricle; RV: right ventricle; Ao: Aorta; LA: Left ventricle; Pulm vein: Pulmonary vein.
Continuous wave (CW) Doppler interrogation shows the inter-ventricular pressure gradient as 81 mm Hg, which is consistent with a restrictive VSD. Small muscular...
Source: Cardiophile MD - December 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Atrial septal defect (ASD) with bidirectional shunt
Subcostal four chamber view shows a large defect in the interatrial septum (ASD). Right atrium (RA) and right ventricle (RV) are dilated, while left atrium (LA) and left ventricle (LV) are not. Blue color on colour flow mapping indicates right to left shunt across the atrial septal defect (R>L Shunt) in the subcostal view as the flow is away from the transducer.
This view shows red coloured flow across the ASD indicating a left to right shunt (L>R shunt). In addition there is a mosaic (multicoloured) jet spreading from the closed tricuspid valve into the right atrium, due to tricuspid regurgitation (TR jet).
Bidirec...
Source: Cardiophile MD - November 29, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Subcostal four chamber view – Echocardiography
Subcostal four chamber view is excellent for visualization of interatrial septum (IAS). If an atrial septal drop out is seen in the apical four chamber (4C) view, it need not be an atrial septal defect as the IAS is parallel to the ultrasound beam in the apical 4 C view. Structures are imaged well only if they are perpendicular to the ultrasound beam. In case of Doppler, the signals are better when it is parallel to the beam. If the beam is perpendicular to the flow, there is hardly any Doppler signal picked up. Subcostal four chamber view shows right atrium (RA), left atrium (LA), right ventricle (RV) and the left ventric...
Source: Cardiophile MD - November 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
Device closure of atrial septal defect (ASD)
Device closure of ASD
Device closure of ASD is suitable for secundum ASD with a good rim all around for holding the two discs together. Trans esophageal echo (TEE) is done to assess the superior, aortic and mitral rims as well as the total septal length. It is ideal to have TEE guidance during the procedure as well. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the ASD. The tip of the wire is placed in the pulmonary vein and a long venous sheath is introduced. Once the sheath is in position, the device attached to the delivery cable is introduce...
Source: Cardiophile MD - September 17, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs
