Paradoxical splitting of second heart sound
Normal split of second heart sound is due to the delay in pulmonary valve closure compared to aortic valve. This is mostly contributed to by the pulmonary hang out interval. Hang out interval is the time taken for the actual valve closure after the pulmonary artery and right ventricular pressure tracings crossover. Normal split of second heart sound closes in expiration as the reduced venous return shortens right ventricular ejection. When the split closes in inspiration and becomes audible in expiration, it is called paradoxical splitting of second heart sound. Please note that a wide split of second heart sound as in ri...
Source: Cardiophile MD - June 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Athlete ’ s heart
Athlete’s heart
Athlete’s heart denotes structural, functional and electrical remodeling seen in trained athletes. It is a physiological adaptation helping athletes perform physical tasks better than non-athletes [1]. Though most of the findings in athlete’s heart are related to the left ventricle, changes do occur in the right ventricle as well.
Effect of exercise on the left ventricle
During aerobic exercise which is isotonic, the heart rate and stroke volume increases. Systemic vascular resistance falls, but slight to moderate increase in blood pressure can occur due to the increased cardiac output. As...
Source: Cardiophile MD - June 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
An 80-something with weakness, cough, and CP. Should this ECG provoke a Prehospital Cath Lab activation?
An 80-something called 911 for chest pain, generalized weakness, and cough.Here is his prehospital ECG:The medics were worried about this ECG and activated the cath labSmith: As in many prehospital ECGs with large voltage,the tracing goes off the image, making assessment of voltage impossible. Thus, it is impossible to assess the ST Segments and T-waves, which should always be assessed in proportion to the size of the QRS. I call this " proportionality " and in a non-ischemic ECG, the repolarization should always be proportional to the depolarization. Since we can ' t see the true size of t...
Source: Dr. Smith's ECG Blog - April 8, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Role of Valsalva maneuver in cardiology
The initial description of Valsalva maneuver was published by Antonio Maria Valsalva in 1704. It was forced expiratory effort against the closed glottis, nose and mouth, lasting for a few seconds. The maneuver was employed with the aim of expelling foreign bodies or exudates from the middle ear [1]. Even today otolaryngologists use variations of the maneuver very often. Edward Weber in 1851 detailed the cardiovascular changes associated with maneuver, making it useful for diagnostic purpose. Hence some authors prefer to call it as Valsalva-Weber maneuver [2].
The classical four phases of Valsalva maneuver and its hemodyn...
Source: Cardiophile MD - April 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Phenocopies of hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is characterized by hypertrophy of the left ventricle, not related to load. It is a genetically transmitted condition. There are several mimickers of hypertrophic cardiomyopathy which can be called phenocopies of hypertrophic cardiomyopathy. Conventional form of HCM has been called sarcomeric HCM as it is due to mutations in genes encoding sarcomeric proteins [1].
Here is a small list of phenocopies of hypertrophic cardiomyopathy which is not truly exhaustive:
Fabry disease
Danon disease
PRKAG2 Cardiomyopathy
Pompe disease
Cardiac amyloidosis
Athlete’s heart
Hypertensive heart disease
...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Mimickers of HCM Mimickers of hypertrophic cardiomyopathy Mimics of HCM Mimics of hypertrophic cardiomyopathy Source Type: blogs
Giant T inversion and NSVT
Giant T inversion with NSVT
Holter tracing showing giant T wave inversion and non sustained ventricular tachycardia, both at the beginning of the tracing and at the end. Ventricular ectopic beats are also seen in between. Variation in QRS amplitude of the NSVT beats are evident. It is likely that this will soon progress to torsades des pointes in the setting of gross QT interval prolongation. QT interval is seen as 640 ms in a cycle with cycle length of 600 ms. So, the QTc will be 640 ms. The first ventricular ectopic is followed by a good compensatory pause while the second one is almost an interpolated ventricular ecto...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
A 50-something with cocaine chest pain and ST Elevation in V1 - V3
CONCLUSIONS -- SUMMARY Moderately increased left ventricular wall thickness.Normal left ventricular size and systolic function with an estimated EF of 68%.No regional wall motion abnormality.Dynamic intracavitary gradient, peak 34 mmHg at rest and mmHg with Valsalva.Indeterminate left-sided diastolic parameters. The hypertrophy is somewhat more prominent at the apex. This, in conjunction with the dynamic intracavitary gradient, raisesconcern for hypertrophic cardiomyopathy. Learning PointsRight precordial ST Elevation: Septal STEMI vs. LVH:Here is a typical case of massive LVH, with secondary ST Elevat...
Source: Dr. Smith's ECG Blog - February 9, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
How to follow up Hypertrophic cardiomyopathy ? : Too much reliance on LVOT gradient is problematic
Hypertrophic cardiomyopathy (HCM) is the most common primary disorder of cardiac muscle. The incidence is about 1 in 500, which would mean 1.5 crore HCM patients will be living on our planet at any moment. The root cause of pathology is located in 20 odd genes that define cardiac muscle protein integrity. (Myosin, Troponin, Titin, etc) This leads to the bizarre architecture of cardiac muscle, prone to progressive fibrosis.(Paradoxically, 90% of HCM have normal or supernormal contractility till very late stages, proving that the much-dreaded term myocardial disarray has little effect on contractility. It is all the more f...
Source: Dr.S.Venkatesan MD - February 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: hypertrophic cardiomyopathy criley concept hocm hcm lobster claw hcm lobster claw is pulsus bisferiens mavacamten explorer trial what is the mechanism of hocm gradient lvot Source Type: blogs
Sarah ’ s Wheat Belly health and life transformation
Sarah’s story reminds us how the simple matter of diet can shape our lives for decades, affecting energy, body weight, emotional health–just about every aspect of our physical and social lives before we finally stumble on the right answers. After many years of struggling with poor health, relying on prescription medications that never addressed underlying causes, it therefore came as a surprise to Sarah that she could indeed achieve magnificent health without the drugs by simply following the diet programmed into human genetic code and supplementing nutrients that are deficient in modern life.
...
Source: Wheat Belly Blog - January 28, 2021 Category: Cardiology Authors: Dr. Davis Tags: Open grain-free Inflammation joint pain wheat belly Source Type: blogs
Why AF is often well tolerated in Hypertrophic cardiomyopathy ?
Up to 25 % of LV filling is done by atrial contraction. Atrial booster function is important in LV outflow lesions. This can be critical in patients who have diastolic deformities of LV. ( an audible or even palpable S4 confirms the atrial kick in these situations ) This is how we were taught for decades right. Still, it may hold good in many left-sided condtions, but in HCM it definitely seems to be not true.
A succinct review of this topic makes a good read.
Incidence if AF in HCM is about 20% (Mostly paroxysmal 70 % , Persistent /Permanent 30 %)
Mechanism of AF IN HCM
Incre...
Source: Dr.S.Venkatesan MD - November 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation af in hocm affirm study atrial fibrillation in hypertrophic cardiomyopathy current guidelines in hcm hcm hocm mechansim of af in hcm pathophysiologyof hcm Source Type: blogs
ECG in coronary artery disease
ECG changes in coronary artery disease (CAD) can be in any of the waves or segments. Diagnosis of acute myocardial infarction in the emergency room still relies mostly on the ECG, though other investigations are there to supplement.
P wave abnormalities
P wave being an atrial event, is not usually involved directly by CAD. But indirectly, there can be evidence of atrial enlargement if there is left ventricular dysfunction. Atrial arrhythmias are observed in atrial infarction.
Abnormalities of PR segment
PR segment contains the atrial repolarization wave (Ta) though it is not usually evident. PR segment depression can occu...
Source: Cardiophile MD - September 28, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC atrial infarction juvenile pattern Juvenile T inversion Loss of R wave progression Pardee’s sign pathological Q waves PR segment depression primary ventricular fibrillation ST segment abnormalities T wave abnormalities 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
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
Young Man with a Heart Rate of 257. What is it and how to manage?
A 30-something was in the ED for some minor trauma when he was noted to have a fast heart rate. He acknowledged that he had palpitations. but only when asked. He had a history heavy alcohol use. Blood pressure was normal (109/83).Here is his 12-lead:There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology.The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle (fascicular...
Source: Dr. Smith's ECG Blog - September 6, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Accordion sign – Cardiology MCQ
Accordion sign – Cardiology MCQ
Accordion sign on magnetic resonance imaging (MRI) is seen in:
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Amyloid cardiomyopathy
Post your answer as a comment below. Correct answer will be published after 2 days.
The post Accordion sign – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - August 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
