MKSAP: 28-year-old pregnant woman with a cardiac murmur
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old pregnant woman is evaluated for a cardiac murmur identified on examination by her obstetrician. She is asymptomatic. She is in her 24th week of pregnancy. Medical history is unremarkable, and there is no family history of heart disease. She takes prenatal vitamins and no other medications.
On physical examination, she is afebrile, blood pressure is 120/70 mm Hg, pulse rate is 86/min, and respiration rate is 18/min. Cardiac examination reveals a midsystolic ejection click followed by a grade 3/6 ear...
Source: Kevin, M.D. - Medical Weblog - June 24, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
Chest pain, Dynamic ST Elevation and T-waves, and High Voltage
A 20-something had sudden severe chest pain while smoking marijuana at a party. After approximately 40 minutes, other people there convinced him to call 911. The patient told the medics that he had had this pain on other occasions and it is because of an " enlarged heart. " He denied SOB, N/V, or other recent illness. His vitals signs were relatively normal.The medics recorded a prehospital ECG which could not be found, but they activated the cath lab based on that ECG.On arrival, the patient was very agitated and would not allow any IVs or blood draws.He stated he had a history of pericarditis and that...
Source: Dr. Smith's ECG Blog - May 25, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why did this patient have ventricular fibrillation?
A previously healthy 50-something collapsed while exercising. He underwent CPR and defibrillation and was brought to the ED.Here is his initial ED ECG:What do you think?Analysis1. Sinus tachycardia due to post arrest state.2. I see no evidence of STEMI or even of subtle coronary occlusion. I see no evidence of ischemia.3. In some leads, there appears to be a very long QT, but it lead II across the bottom is used, it becomes apparent that the P-wave is mimicking the T-wave in some leads. QT is normal.4. There is no evidence of structural heart disease or congenital ion channel disease.5. There are non-diagnos...
Source: Dr. Smith's ECG Blog - March 13, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
All about alternans
Here is all you wanted to know about alternans: Traube’s pulse, total pulsus alternans, diastolic pulsus alternans, right ventricular pulsus alternans, biventricular pulsus alternans and electrical alternans!
Traube’s pulse – pulsus alternans
Pulsus alternans or Traube’s pulse was described by Ludwig Traube in 1872 [1]. Pulsus alternans is nothing but alternating pulses having different volumes and is a feature of left ventricular dysfunction. It is well known that pulsus alternans can be augmented by a premature ventricular contraction [2].
A rare case of pulsus alternans due to 2:1 left bundle branch...
Source: Cardiophile MD - January 25, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology biventricular pulsus alternans Brody's effect diastolic pulsus alternans electrical alternans right ventricular pulsus alternans total pulsus alternans Traube's pulse 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
Cardiomyopathy Quiz
Short quiz on cardiomyopathy
Cardiomyopathy Quiz
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Question 1AV block in the presence of features of dilated cardiomyopathy (DC...
Source: Cardiophile MD - December 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Syncope Several Times, Complete Heart Block, And a Surprise ECG in the ED!
This was sent by one of our graduates who will remain anonymous.A 55 year old male with a history of DM and HTN had 2 syncopal episodes, then a third while in the presence of EMS. There was no drug use.ECG 1. He was put on the monitor and it showed this:There is a slow, wide complex. There are P-waves that are regular but completely dissociated from the QRS. In fact, they don ' t ever conduct.So it is third degree heart block with a ventricular escape.ECG 2. Within minutes, his heart rate normalized:Normal sinus rhythm, diffuse non-specific T-wave inversionECG 3. He had no complaints on arrival to the ED. Th...
Source: Dr. Smith's ECG Blog - December 6, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Right Precordial T-wave Inversion
This was posted on Facebook EKG club byMassimo Bolognesi, from Italy. He is a highly respected Sports Medicine Cardiologist.https://www.facebook.com/Maxb1953?fref=tshttp://www.dottorbolognesi.it/He graciously allowed me to re-post it here." This ECG was recorded on an asymptomatic 50 year old marathon runner who presented for pre-participation screening. "(This ECG could easily be seen in an ED chest pain patient, and I have seen many)What do you think?DescriptionSinus bradycardia.There is high voltage.There is ST elevation in V2 and V3There are inverted T-waves in V2 and V3There are prominent U-waves in V2 and V3Many...
Source: Dr. Smith's ECG Blog - December 4, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Young Man with Recurrent Chest Pain and Dyspnea with Exertion
CaseThis is a young man who has had chest pain and dyspnea with exertion for years. He presented to the ED with these symptoms again. On this occasion, the CP was associated with stress and accompanied by some SOB, 7/10 at it ' s worse and made worse with activity, with radiation up into the left side of his neck and face.No h/o hypertension.Here is the ECG:Probable Diagnosis?I was shown this ECG and gave my opinion, as below.Here is an ED bedside echo, parasternal long axis:Look at the small the end-systolic LV chamber sizeParasternal short axis:Again, look at the end-systolic chamber size!What is the Diagnosis?...
Source: Dr. Smith's ECG Blog - November 29, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Deep T inversion
First few conditions which come to our mind when we see deep T wave inversions are coronary artery disease, hypertrophic cardiomyopathy, post cardiac arrest state and takotsubo cardiomyopathy. Other conditions in which deep T wave inversion have been reported are nonischemic cardiomyopathy [1], after cardioversion [2], acute pulmonary embolism [3] and acute pulmonary edema [4].
References
Ambhore A, Teo SG, Poh KK. Diabetes mellitus and heart disease. Singapore Med J. 2013 Jul;54(7):370-5; quiz 376.
Sovari AA, Farokhi F. When the heart remembers. Am J Emerg Med. 2007 Sep;25(7):831-3.
Punukollu G, Gowda RM, Khan IA, Wilbur...
Source: Cardiophile MD - November 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology ECG / Electrophysiology ECG Library Source Type: blogs
Imprecise Medicine: Genetic Tests Lead To Misdiagnosis
–Some black Americans were wrongly told they had a high risk for hypertrophic cardiomyopathy. Precision medicine offers the promise of an accurate assessment of individual risk for serious conditions like hypertrophic cardiomyopathy (HCM). But a new report published in the New England Journal of Medicine,” which the authors describe as “a cautionary tale of broad...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - August 17, 2016 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics genetics Hypertrophic cardiomyopathy precision medicine Source Type: blogs
Mechanism of reverse pulsus paradoxus
Reverse pulsus paradoxus is an expiratory fall in pulse volume, the opposite of pulsus paradoxus. The classical causes of reverse pulsus paradoxus described are [1]:
Isorhythmic atrioventricular (AV) dissociation
Hypertrophic obstructive cardiomyopathy
Intermittent positive pressure ventilation (IPPV)
During IPPV the swings in intrathoracic pressure is opposite to that of normal breathing. Hence the inspiratory blood pressure is higher than the expiratory blood pressure [2]. During the inspiratory phase, increased intrathoracic pressure of positive pressure ventilation is transmitted to the thoracic aorta. In addition t...
Source: Cardiophile MD - August 8, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
MOGE(S) classification for cardiomyopathies
Conventionally cardiomyopathies have been classified into hypertrophic, restrictive and dilated varieties [1]. This classification is based on the phenotye rather than the genotype. With advances in genetic studies, several genes related to cardiomyopathies have been described. Hence in 2013, World Heart Federation proposed a classification including the genotype and phenotype of cardiomyopathies called as MOGE(S) classification [2]. This system of classification resembles the TNM classification for malignant neoplasms [3].
The reason for adding genotype information to the classification was the difference in risks asssoc...
Source: Cardiophile MD - August 3, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Featured Source Type: blogs
Heyde ’ s syndrome: Acquired von Willebrand Syndrome in Severe Aortic Stenosis
Severe gastrointestinal bleeding can occur in those with severe aortic stenosis (Heyde’s syndrome). The initial description was in 1958 [1]. An important mechanism for the bleeding is deficiency of large von Willebrand factor multimers. This is due to the structural damage to the large protein when blood passes through the severely stenotic aortic valve as a high velocity jet. Loss of large multimers can be measured as the large von Willebrand factor multimer index and it is significant if it is less than 80% [2]. Anemia due to Heyde’s syndrome improves after aortic valve replacement. The gastro intestinal blee...
Source: Cardiophile MD - August 1, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 3
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Source: Cardiophile MD - July 9, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
