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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

How is management of polymorphic VT differ from monomorphic VT ?
Ventricular tachycardia is a regular wide qrs tachycardia.It can be monomorphic or polymorphic. General diagnostic rules In VT (Gross though, with considerable overlap) Polymorphic VT is more often Ischemic , drug induced, electrolytic, and includes many inherited VTs .Most primary ischemic VT are polymorphic. Monomorphic VT occurs more common with structurally abnormal heart.(DCM, HOCM, ARVD etc .Please note late scar induced VT are often monomorphic , which is also being referred to as Ischemic VT in literature ) *Its important to realise any VT will transform to polymorphic just pri...
Source: Dr.S.Venkatesan MD - September 22, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 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

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

Why we may “never-ever” understand the seriousness of NSVT in HOCM ?
Hypertrophic cardiomyopathy (HCM) is the most common primary cardiac muscle disorder.It is one of the extensively studied medical entity in terms of pathology, genetics, electrophysiology and treatment.Though it has dramatic myocardial phenotypic expression , longevity can be near normal except in a minority who are prone for LV dysfunction and SCD due to the indirect electrical instability.These arrhythmia arise due to myocardial disarray , micro vascular disease or fibrosis. NSVT by definition is runs of VT at a rate of > 100 /mt occurring less than 30 seconds. How common is NSVT in HCM ? On Holter study ...
Source: Dr.S.Venkatesan MD - April 3, 2016 Category: Cardiology Authors: dr s venkatesan Tags: hocm hcm how to manage non sustained vt in hcm hoc hypertrophic cardiomyopathy icd for nsvt managment issues in hocm nsvt in hocm sustained vs nonsustained vt in hocm Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 22
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Source: Cardiophile MD - March 21, 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

DM / DNB Cardiology Entrance Mock Test 16
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Source: Cardiophile MD - February 14, 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

DM / DNB Cardiology Entrance Mock Test 13
In this study, cangrelor was discontinued 1-6 hours prior to surgery, while aspirin was continued throughout the perioperative period. Bridging with cangrelor did not increase major bleeds prior to surgery, though minor bleeds, mostly ecchymosis at venipuncture site, was higher. P2Y12 assay documented sufficient platelet inhibition corresponding to levels required for anti thrombotic effect [1]. Cangrelor is awaiting approval and more large scale trials regarding the use of bridging are needed. Reference 1. Angiolillo DJ et al; BRIDGE Investigators. Bridging antiplatelet therapy with cangrelor in patients undergoing ...
Source: Cardiophile MD - February 7, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 6
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Source: Cardiophile MD - January 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 5
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 5. You scored %%SCORE%% out of %%TOTAL%%. Your performance...
Source: Cardiophile MD - January 20, 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

DM / DNB Cardiology Entrance Mock Test 4
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 4. You scored %%SCORE%% out of %%TOTAL%%. Your performan...
Source: Cardiophile MD - January 18, 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

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 During intermittent positive pressure ventilation 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]. In case of isorhythmic AV dissociation, inspiratory increase in sinus rate results in sinus rhythm dominating over AV dissociation. In sinus ...
Source: Cardiophile MD - December 19, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

A large R-wave in lead V1. And why is the PR interval not short?
This 20-something male presented with alcohol withdrawal, alcoholic hepatitis, and alcoholic steatosis. There was no chest pain or syncope, but an ECG was recorded as part of his workup.What is it?I received this message about it:Steve,I was just looking back at this patient and noticed that he was diagnosed with WPW based on his ED EKG, and I certainly did not pick up on it. I was thinking it looked like an incomplete right bundle pattern. I'm curious about the EKG - the admitting IM resident notes "wide QRS and delta wave with short PR" but his PR is 152 and 145 on both EKGs. Looking at it, I see the delta wa...
Source: Dr. Smith's ECG Blog - September 6, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

A large R-wave in lead V1
This 20-something male presented with alcohol withdrawal, alcoholic hepatitis, and alcoholic steatosis. There was no chest pain or syncope, but an ECG was recorded as part of his workup.What is it?I received this message about it:Steve,I was just looking back at this patient and noticed that he was diagnosed with WPW based on his ED EKG, and I certainly did not pick up on it. I was thinking it looked like an incomplete right bundle pattern. I'm curious about the EKG - the admitting IM resident notes "wide QRS and delta wave with short PR" but his PR is 152 and 145 on both EKGs. Looking at it, I see the delta wa...
Source: Dr. Smith's ECG Blog - September 6, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs