History of Hypertrophic Cardiomyopathy (HOCM), with Tachycardia and High Lactate
A patient under 40 with h/o HOCM and implantable cardioverter-defibrillator (for secondary prevention of VF arrest that occurred during exertion) presented with chest pain, diaphoresis, and tachycardia. Earlier in the day, the patient had been physically active, which resulted in dizziness, SOB and diaphoresis. Then later, there was alcohol consumption associated with further physical exertion. The patient presented clutching the chest, dizzy, SOB, diaphoretic. BP was 165/109 (a good example of shock in which the BP is maintained by high systemic vascular resistance).Here is her ED ECG:There is a na...
Source: Dr. Smith's ECG Blog - June 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
2014 Heart Rhythm Society Sessions — My massive recap:
Hey Everyone,
I recently returned from the Heart Rhythm Society meeting in San Francisco. I attended the meeting as both a physician-journalist-columnist for theHeart.org and as a practicing electrophysiologist. As it so often is with international meetings, I returned energized and rejuvenated about the practice of medicine. Medical meetings are great this way.
It’s quite sad that fewer doctors are traveling to meetings. It’s a missed opportunity for learning, and shall I say, rekindling of the spirit of doctoring. Sure, social media allows a semblance of virtual attendance, and this is better than no attendance, but ...
Source: Dr John M - May 15, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Bisferiens pulse (Pulsus bisferiens)
Bisferiens pulse may be seen in all of the following except:
1. Free aortic regurgitation
2. Combination of aortic regurgitation and stenosis
3. Hypertrophic obstructive cardiomyopathy
4. Fallot’s tetralogy
Correct answer: 4) Fallot’s tetralogy
Bisferiens pulse (pulsus bisferiens) has two systolic peaks and is seen in both free (severe) aortic regurgitation and a combination of aortic regurgitation and stenosis, especially when the regurgitation is dominant. In severe aortic stenosis, the pulse is low volume and slow peaking – pulsus parvus et tardus. In hypertrophic obstructive cardiomyopathy (HOCM), soo...
Source: Cardiophile MD - April 16, 2014 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ Source Type: blogs
Important lessons from the collapse of NHL player Rich Peverly
Last night my Twitter stream lit up with the news that NHL player Rich Peverly collapsed from a heart arrhythmia. Fortunately, he was successfully treated, and is reported to be in good condition.
Here is a link to the best story I could find. It sounds awfully significant.
[Dr.] Salazar said of the treatment, “We provided oxygen for him. We started an IV. We did chest compressions on him and defibrillated him, provided some electricity to bring a rhythm back to his heart, and that was successful with one attempt, which is very reassuring.”
A couple of things to clarify about this matter. First, cardiac arrest is diffe...
Source: Dr John M - March 11, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Important lessons from the collapse of NHL player Rich Peverley
Last night my Twitter stream lit up with the news that NHL player Rich Peverley collapsed from a heart arrhythmia. Fortunately, he was successfully treated, and is reported to be in good condition.
Here is a link to the best story I could find. It sounds awfully significant.
[Dr.] Salazar said of the treatment, “We provided oxygen for him. We started an IV. We did chest compressions on him and defibrillated him, provided some electricity to bring a rhythm back to his heart, and that was successful with one attempt, which is very reassuring.”
A couple of things to clarify about this matter. First, cardiac arrest is diff...
Source: Dr John M - March 11, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Systolic anterior motion of mitral valve after valve surgery
Systolic anterior motion (SAM) of anterior mitral leaflet (AML) is a classical finding in hypertrophic obstructive cardiomyopathy and it is a factor causing the obstruction as well as associated mitral regurgitation. But systolic anterior motion of the anterior mitral leaflet can also occur without hypertrophic cardiomyopathy, after repair of mitral valve. If the leaflet is very redundant, there can be SAM when the left ventricular size decreases after valve repair and if the ventricle is hyperdynamic. This is more likely when the distance between the valve coaptation point and the interventricular septum. (Source: Cardiophile MD)
Source: Cardiophile MD - January 1, 2014 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery SAM SAM of AML SAM of mitral valve Source Type: blogs
Modified Carpentier functional classification of mitral valve disease
Carpentier in 1980s described a classification, mainly for mitral regurgitation, from the point of view of surgical repair. It took into account the etiology, pathology and pathophysiology of mitral valve dysfunction. Initial classification had classes I-III with subclasses while classes IV and V were added later. In type I, motion of leaflet margin is normal while there is prolapse or flail leaflet in type II. In type IIIa there is restricted leaflet opening while type IIIb has restricted leaflet closure. Type IVa has systolic anterior motion and type V has features of more than one of the other types. Type I occurs in va...
Source: Cardiophile MD - December 27, 2013 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Type of left ventricular hypertrophy in mitral regurgitation
Type of left ventricular hypertrophy (LVH) in mitral regurgitation is:
a) Eccentric hypertrophy
b) Concentric hypertrophy
c) Asymmetric hypertrophy
d) None of the above
Correct answer: a) Eccentric hypertrophy
Eccentric hypertrophy is dilatation of cavity with thickening of the wall and occurs in regurgitant lesions like mitral regurgitation and aortic regurgitation. Concentric hypertrophy is without dilatation of cavity as occurs in stenotic lesions (aortic stenosis, coarctation of aorta) and hypertension. Asymmetric hypertrophy of septum is characteristic of hypertrophic obstructive cardiomyopathy. (Source: Cardiophile MD)
Source: Cardiophile MD - October 28, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Asymmetric hypertrophy Concentric hypertrophy Eccentric hypertrophy LVH Source Type: blogs
Take Me Out to the Ballgame
A 31-year-old man presented to the ED with syncope. He was previously healthy, takes no medications, and had run a marathon the day before. He was riding the light rail home from a baseball game when he developed vague 4/10 epigastric abdominal pain associated with nausea and diaphoresis. He remembers feeling lightheaded and flushed before momentarily passing out.
His wife said he became quite pale immediately beforehand. He did not have any headache, chest pain, or shortness of breath before or after the syncopal episode. He has a significant family history of premature coronary artery disease. He had normal vital signs ...
Source: Spontaneous Circulation - October 11, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Take Me Out to the Ballgame
A 31-year-old man presented to the ED with syncope. He was previously healthy, takes no medications, and had run a marathon the day before. He was riding the light rail home from a baseball game when he developed vague 4/10 epigastric abdominal pain associated with nausea and diaphoresis. He remembers feeling lightheaded and flushed before momentarily passing out.
His wife said he became quite pale immediately beforehand. He did not have any headache, chest pain, or shortness of breath before or after the syncopal episode. He has a significant family history of premature coronary artery disease. He had normal vital signs...
Source: Spontaneous Circulation - October 11, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
palpating your patient’s radial pulse.
To palpate a radial pulse, use the sensitive tips of your first three fingers over the expected radial pulse site.
To be specific: at the wrist…lateral to the flexor carpi radialis tendon.
You can use your other hand to support the patients wrist.
Once it has been located, some nurses like to just use two fingers over the pulse.
The pulse is felt as a pressure wave produced by ventricular ejection during systole. Interestingly this pressure wave travels down the artery much faster than the blood itself (5 metres/sec versus 40–50 centimetres/sec respectively).
With increased age, or due to changes in the wall of the art...
Source: impactEDnurse - July 26, 2013 Category: Nurses Authors: impactEDnurse Tags: clinical skills Source Type: blogs
Cardiology MCQ Online 5
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Source: Cardiophile MD - July 15, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ Test 5
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Source: Cardiophile MD - July 15, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ Online 4
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You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. We strongly advise you t...
Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG Echocardiography Source Type: blogs
Cardiology MCQ Test 4
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You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. W...
Source: Cardiophile MD - July 14, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG Echocardiography Source Type: blogs
