M-mode echocardiogram in left ventricular dysfunction
M-mode echocardiogram in left ventricular dysfunction
M-mode echocardiogram is commonly used to measure left ventricular dimensions and ejection fraction. Ejection fraction is indicative of the left ventricular systolic function. In this case left ventricular systolic function is grossly depressed, with a left ventricular ejection fraction (EF) of only 31.1%. Usually the left ventricular cavity is also significantly dilated when there is severe left ventricular dysfunction. But here it is within the normal range. IVSd: Interventricular septal septum, diastolic; LVIDd: Left ventricular internal diameter, diastolic; LVPWd: ...
Source: Cardiophile MD - September 12, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Uncategorized Spherical formula for calculation of ejection fraction Teichholz formula Source Type: blogs
Update on hypertrophic cardiomyopathy
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - July 21, 2018 Category: Internal Medicine Tags: cardiovascular Source Type: blogs
Resuscitated cardiac arrest – Cardiology MCQ – Answer
Thirty year old male was resuscitated from cardiac arrest. His temperature was 37 degrees centigrade and serum potassium was 4.5 mEq/litre. ECG showed an abnormal wave at the end of the QRS complex. He is likely to have:
Correct answer: c) Arrhythmogenic right ventricular dysplasia
The wave at the end of the QRS is likely to be Epsilon wave. It is sometimes called ‘post excitation’ by analogy with the delta wave seen at the beginning of the QRS in pre-excitation. Hypothermia and hypokalemia can cause cardiac arrest, which are excluded from the data given. Osborne wave in hypothermia is also seen at the end ...
Source: Cardiophile MD - June 12, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Resuscitated cardiac arrest – Cardiology MCQ
Thirty year old male was resuscitated from cardiac arrest. His temperature was 37 degrees centigrade and serum potassium was 4.5 mEq/litre. ECG showed an abnormal wave at the end of the QRS complex. He is likely to have:
a) Hypertrophic obstructive cardiomyopathy
b) Long QT syndrome
c) Arrhythmogenic right ventricular dysplasia
d) Acute myocardial infarction
Please post your answer as a comment below. Correct answer will be published on: Jun 12, 2018 @ 19:45 (Source: Cardiophile MD)
Source: Cardiophile MD - June 10, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Heart disease in pregnancy: Risk stratification
It is needless to say that heart disease in pregnancy is a challenge for the obstetrician and the cardiologist. Hemodynamic changes in pregnancy and labour can adversely affect many of the significant cardiac lesions. Increase in blood volume and heart rate are the important factors during pregnancy. In general stenotic lesions and pulmonary hypertension are poorly tolerated, while regurgitant lesions are better tolerated. Specific risks like aortic dissection and rupture are there for coarctation of aorta. Several risk stratification schemes have been developed for assessing the risk of pregnancy with heart disease over ...
Source: Cardiophile MD - May 27, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology CARPREG II risk scoring CARPREG risk stratification mWHO classification ZAHARA risk score Source Type: blogs
Is there any role for simultaneous LV and RV angios?
Simultaneous LV and RV angios (left ventricular and right ventricular angiograms or ventriculograms) used to be done in hypertrophic cardiomyopathy (asymmetric septal hypertrophy) before the advent of echocardiography to delineate the interventricular septum. When both ventricles are opacified by iodinated radio contrast, interventricular septum will be seen as a negative shadow.
To take simultaneous LV and RV angios we will need:
Dual vascular access (arterial and venous)
Two angiographic catheters (one right ventricular angiographic catheter like NIH catheter and one left ventriculographic catheter like pig tail ca...
Source: Cardiophile MD - May 25, 2018 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
Arrhythmia in HCM – Cardiology MCQ – Answer
Commonest sustained arrhythmia in hypertrophic cardiomyopathy:
Correct answer: d) Atrial fibrillation
Atrial fibrillation (AF) can occur in about 1/5th of cases of hypertrophic cardiomyopathy (HCM). Factors predisposing to AF in HCM are left atrial pressure and size due to left ventricular diastolic dysfunction, left ventricular outflow tract obstruction and mitral regurgitation. About one fourth of them may develop embolic episodes and stroke. It has been suggested that those with left atrial diameter of 45 mm or more should undergo 48 hour Holter once or twice a year to look for AF. Anticoagulation is recommended in tho...
Source: Cardiophile MD - April 28, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Digoxin in HCM – Cardiology MCQ – Answer
Digoxin in hypertrophic cardiomyopathy – pick the correct statement:
Correct Answer: c) Low dose digoxin can be used to control ventricular rate in those with ejection fraction less than 50%, having NYHA class II-IV symptoms and permanent atrial fibrillation (Class Iib, level of evidence C, 2014 European Society of Cardiology Guidelines)
Being an inotropic agent digoxin can enhance the left ventricular outflow tract obstruction (LVOTO). Even in those without LVOTO, digoxin is not recommended, except in the specific subset mentioned above, that too only as a Class IIb recommendation.
Reference
1. Elliott PM, Anastasakis A...
Source: Cardiophile MD - April 27, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Arrhythmia in HCM – Cardiology MCQ
Commonest sustained arrhythmia in hypertrophic cardiomyopathy:
a) Ventricular tachycardia
b) Ventricular fibrillation
c) Atrial tachycardia
d) Atrial fibrillation
Post your answer as a comment below. Correct answer will be published on: Apr 28, 2018 @ 20:18
The post Arrhythmia in HCM – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - April 26, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Septal myectomy eponym – Cardiology MCQ – Answer
Ventricular septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) is otherwise known as:
Correct answer: c) Morrow procedure
In Morrow procedure, a rectangular trough is created in the basal left ventricular septum from below the aortic valve to a point beyond the point of contact of the anterior mitral leaflet to the septum (point of SAM septal contact). It is the procedure of choice for symptomatic drug refractory HOCM, provided it is done in centers with adequate experience with the procedure.
Jatene procedure is arterial switch operation for complete transposition of great arteries. Mustard and Senning pro...
Source: Cardiophile MD - April 26, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Digoxin in HCM – Cardiology MCQ
Digoxin in hypertrophic cardiomyopathy – pick the correct statement:
a) Can be used for relief of exertional dyspnea in those with left ventricular outflow tract obstruction and LVEF >50%
b) Used for control of ventricular rate in those with atrial fibrillation and left ventricular outflow obstruction
c) Low dose digoxin can be used to control ventricular rate in those with ejection fraction less than 50%, having NYHA class II-IV symptoms and permanent atrial fibrillation
d) None of the above
Post your answer as a comment below. Correct answer will be published on: Apr 27, 2018 @ 19:44
The post Digoxin in HCM –...
Source: Cardiophile MD - April 25, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Septal myectomy eponym – Cardiology MCQ
Ventricular septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) is otherwise known as:
a) Jatene procedure
b) Senning procedure
c) Morrow procedure
d) Mustard procedure
Please post your answer as a comment below. Correct answer will be published on: Apr 26, 2018 @ 19:41
The post Septal myectomy eponym – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - April 24, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Beta blocker in HOCM – Cardiology MCQ – Answer
Which of the following beta blockers is not an ideal choice in the treatment of hypertrophic obstructive cardiomyopathy?
Correct answer: d) Carvedilol
Non vasodilating betablockers are recommended for the treatment of hypertophic obstructive cardiomyopathy (Class I, Level of Evidence B, as per European Society of Cardiology Recomendations 2014). Other class I drug recommendation when beta blockers are not tolerated is verapamil. Disopyramide has a class I recommendation in combination with betablocker or verapamil.
Reference
1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, L...
Source: Cardiophile MD - April 24, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Disopyramide in HCM – Cardiology MCQ – Answer
Disopyramide is a class Ia antiarrhythmic agent which can be used in hypertrophic obstructive cardiomyopathy when beta blockers alone are ineffective. Pick out the WRONG statement regarding disopyramide in this context:
Correct answer: c) Should not be combined with verapamil
Disopyramide has a negative inotropic action and is useful in reducing left ventricular outflow tract gradients in hypertrophic obstructive cardiomyopathy and does not increase the risk of sudden cardiac death. Dose reduction is recommended when QTc exceeds 480 ms. It should be avoided in those with glaucoma and men with prostatic symptoms in view of ...
Source: Cardiophile MD - April 24, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
HCM exercise BP – Cardiology MCQ – Answer
Abnormal exercise blood pressure response in hypertrophic obstructive cardiomyopathy has been defined as:
Correct answer: b) Failure to rise at least 20 mm Hg or fall of at least 20 mm Hg from peak level
Abnormal exercise blood pressure response in hypertrophic obstructive cardiomyopathy has been associated with increased risk of sudden cardiac death in younger individuals below the age of 40 years.
Progressive increase in blood pressure upto peak exercise is the normal physiological response to exercise.
Reference
1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G,...
Source: Cardiophile MD - April 23, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
